Future Management and Unmet Needs in Myelofibrosis


Dr. Bose shares his vision for the future management of patients with intermediate myelofibrosis, including the unmet needs with current treatment options and the emerging data he is closely following.

Case: Intermediate-Risk Primary Myelofibrosis in a 68-Year-Old Woman

Clinical Presentation:

  • A 68-year-old woman presented to her physician with symptoms of mild fatigue.
  • Spleen was palpable 6-7 cm below the left costal margin.

PM: No known comorbidities

Initial Clinical Workup and Diagnosis:

  • NGS Testing: JAK2 V617F mutation
  • Karyotype: 46XX
  • BM biopsy: megakaryocyte proliferation and atypia with evidence of reticulin fibrosis
  • Blood smear: leukoerythroblastosis
  • Diagnosis: Primary myelofibrosis
  • Risk:
    • DIPSS: Intermediate-2
    • Mipss70: Intermediate risk
  • Lab Values
    • RBC 3.40 x 1012/L
    • Hgb 9.7 g/dL
    • HCT 32.3%
    • MCV 94 fL
    • WBC 23.0 x 109/L
    • PLT 450 x 109/L
    • PB Blasts <1%

Initial Treatments:

  • Initiated on ruxolitinib.
    • The patient was not interested in transplant.
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