Clinical Pearls for the Treatment of Patients with Myelofibrosis

Case: A 62-Year-Old Man with Myelofibrosis

Clinical Presentation:

• A 62-year-old man presented with symptoms of fatigue, night sweats, and increased bruising.
• PMH: type 2 diabetes, hypercholesteremia, and hypertension
• 1 year prior, patient had a “normal” physical and blood work.
  • PCP noticed lower Hg (11 to 9.5 g/dL) and Plt (350 to 195 cells/m3)
• Patient was referred to Hem/Onc – first available appoint in 2 months.

Initial Clinical Workup and Diagnosis (Post-PCP Visit):

• Exam: fatigue and night sweats worsening; bone pain.
• Labs: RBC 3.40 x 1012/L; Hb 8.7 g/dL; Hct 36%; MCV 94fL; WBC 28.0 x 109/L; Plt 75 x 109/; LDH 330 IU/L
• Spleen: 5 cm below LCM
• Bone Marrow Fibrosis: Grade 2
• Bone Marrow Blasts: 3%
• Blood Smear: leukoerythroblastosis; 1% blasts by manual count/flow cytometry
• Molecular Analysis: JAK V617F+
• ECOG PS 2
• Diagnosis: Primary MF

Current Treatments:

• Patient was initiated on pacritinib.