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

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

Case: A 76-Year-Old Woman with Myelofibrosis

Initial presentation

  • 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.
    • PMH:
      • Hypertension (controlled)
      • Glaucoma
      • Asthma (controlled with inhalers)
    • SMH: (-) nonsmoker; has an occasional drink during book club with her girlfriend
    • 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

Clinical workup

  • Current Labs: (baseline labs were within normal limits at her last examination one year ago)
    • Platelet count: 44 x 109/L
    • Hgb: 8g/dL
    • WBC count: 27 x 109/L
  • Bone Marrow Biopsy
    • Shows a hypercellular bone marrow, increase in atypical appearing megakaryocytes and MF-2 fibrosis, no increase in blasts by CD34+ IHC, aspirate without spicules
  • Molecular testing
    • JAK-V617F mutation: positive at 44%, NGS panel only identified TET2 mutation at a VAF of 17%

Treatment

  • SM complaining of increasing fatigue and abdominal pain and on PE, shows splenomegaly
  • Treatment started with pacritinib 200mg BID
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John Mascarenhas, MD, an expert on myelofibrosis
John Mascarenhas, MD, an expert on myelofibrosis
John Mascarenhas, MD, an expert on myelofibrosis
John Mascarenhas, MD, an expert on myelofibrosis
John Mascarenhas, MD, an expert on myelofibrosis
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