A 76-Year-Old Woman with Newly Diagnosed MF

Anthony Hunter, MD, presents the case of a 76-year-old woman with newly diagnosed primary myelofibrosis with a JAK2 mutation, for which he recommended treatment with momelotinib due to her moderate anemia and refusal of transplant.

Anthony Hunter, MD, presents the case of a 76-year-old woman with newly diagnosed primary myelofibrosis with a JAK2 mutation, for which he recommended treatment with momelotinib due to her moderate anemia and refusal of transplant.

Myelofibrosis can be categorized as primary (developing de novo) or secondary (arising in patients with pre-existing MPNs), and it further distinguishes between proliferative and cytopenic types, with each type having its unique diagnostic criteria and implications for treatment.

Anthony Hunter, MD, details the primary goals when treating a typical patient with myelofibrosis, such as improving symptoms like weight loss and fatigue, addressing anemia, and, more recently, striving to extend survival, with treatments like JAK inhibitors showing potential for improving overall survival in patients.

Dr Anthony Hunter explains that the decision to initiate therapy in patients with myelofibrosis is individualized, considering factors like symptoms and risk stratification; early treatment with JAK inhibitors is crucial for symptom control, but allogeneic stem cell transplant remains the only potential curative therapy, particularly for higher-risk patients.

Momelotinib, a recently approved treatment for myelofibrosis, targets multiple pathways,and offers a promising approach to improve anemia, especially in patients who did not respond optimally to previous JAK inhibitors.

Anthony Hunter, MD, explains that anemia is a common complication in patients with myelofibrosis, often worsening over time; treatment strategies involve monitoring, transfusion support, and considering additional anemia-directed agents.

The SIMPLIFY-1 trial investigated the use of momelotinib in JAK inhibitor-naive patients with myelofibrosis, primarily symptomatic with spleen enlargement, hepatomegaly, or anemia; results showed momelotinib led to improved transfusion independence, reduced transfusion burden, and decreased anemia compared to ruxolitinib.

Dr Anthony Hunter reviews the other three approved JAK inhibitors for treatment of myelofibrosis: ruxolitinib, fedratinib, and pacritinib.

Anthony Hunter, MD, closes his discussion by sharing advice for clinicians treating patients with myelofibrosis.