Balancing Toxicity Concerns with Achieving Adequate Response in Myelofibrosis

Case: A 63-Year-Old Man with Myelofibrosis

Clinical Presentation:

• A 63-year-old man recently diagnosed with primary MF and initiated on 10 mg BID ruxolitinib.
• PMH: type 2 diabetes, hypercholesteremia, and hypertension, squamous cell carcinoma (SCC)

Follow up and Clinical Workup at 3 Months:

• Exam: night sweats improved.
• Labs: Hb 7.8 g/dL; Plt 80 x 109/L (previously 135k) stabilized.
• Some spleen reduction.
• Patient receives ~1 unit RBC per month.

Follow up and Clinical Workup at 6 Months:

• Patient reports complaints of fatigue and abdominal pain.
• Labs: Plt 55 x 109/L; Hgb 6.8 g/dL
• Patient now receives 2 units RBC per month.
• Experienced recurrence of SCC.