Initial Impressions and Comparison to Typical Cases

Opinion
Video

Dr. Bose discusses his initial impressions of the case and how it compares to typical myelofibrosis cases seen in his practice.

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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