John Mascarenhas, MD

Case: A 76-Year-Old Woman with Myelofibrosis

SM is a 76 y/o woman who visits her primary care physician for her annual checkup. She reports having fatigue, occasional night sweats and abdominal discomfort under left rib for the past 2 months. She also mentioned that she feels pain in her bones, but she just attributes that to her “old age.”

SM spends most of her days gardening followed by baking, her 2 favorite activities. Lately, she feels tired after just spending 1 hour gardening and has no energy to bake afterwards.

Since her last examination a year ago, SM has lost close to 12 lbs. She says she has not been dieting and has not noticed a change in her eating habits.

SMH: (-) nonsmoker; has an occasional drink during book club with her girlfriends

FH: she lives alone but her daughter and sister live close by; no family history of cancer

PE: abdominal exam reveals spleen palpable 4cm below left coastal margin visible bruising


Current Labs: (baseline labs were within normal limits at her last examination one year ago)

Shows a hypercellular bone marrow, increase in atypical appearing megakaryocytes and MF-2 fibrosis, no increase in blasts by CD34+ IHC, aspirate without spicules

 mutation: positive at 44%, NGS panel only identified TET2 mutation at a VAF of 17%


SM complaining of increasing fatigue and abdominal pain and on PE, shows splenomegaly

Treatment started with pacritinib 200mg BID

Videos

Dr John Mascarenhas looks to the future of myelofibrosis treatment and shares some ongoing clinical trials and potential treatments that excite him.

The Future of Myelofibrosis Treatment

John Mascarenhas, MD, describes his personal experience with using pacritinib to treat patients with myelofibrosis and reviews the study design and outcomes for both the PERSIST-1 and PERSIST-2 trials.

Review of the PERSIST-1 and PERSIST-2 Trials

SMH: (-) nonsmoker; has an occasional drink during book club with her girlfriend

Dr John Mascarenhas reviews the mechanism of action of pacritinib, a selective JAK2 inhibitor.

Mechanism of Action of Pacritinib

An expert describes the factors he considers when choosing a treatment for a patient with myelofibrosis, and how he judges treatment response.

Considerations in Choosing a Treatment for Myelofibrosis

Dr John Mascarenhas explains the differences between myelofibrosis phenotypes and why it affects treatment regimen choices.

Clinical Phenotypes in Patients with Myelofibrosis

John Mascarenhas, MD, presents the case of a 76-year-old woman with myelofibrosis and provides his initial impressions.

John Mascarenhas, MD | Authors

Articles

The Future of Myelofibrosis Treatment

Review of the PERSIST-1 and PERSIST-2 Trials

Mechanism of Action of Pacritinib

Considerations in Choosing a Treatment for Myelofibrosis

Clinical Phenotypes in Patients with Myelofibrosis

Case Presentation: A 76-Year-Old Woman with Myelofibrosis