Catriona Jamieson, MD, PhD, team leader for the Division of Hematology/Oncology at UC San Diego Health Moores Cancer Center, discusses treatment considerations for patients with myelofibrosis.

The treatment for patients with myelofibrosis is now starting earlier in the disease course, according to Jamieson. For example, those with low-risk disease can receive pegylated interferon, which has demonstrated encouraging results and may reduce the level of bone marrow scarring, Jamieson says. Additionally, patients who are symptomatic can be treated with JAK2 inhibitors, such ruxolitinib (Jakafi), or fedratinib (Inrebic) for those with intermediate- to high-risk disease. 

Both drugs are available in the first-line setting, and patients can decide between the agents based on their safety profile, although one of the primary adverse effects is financial toxicity, Jamieson notes. In addition to improving quality-of-life, ruxolitinib and fedratinib can modify disease trajectory, and improve overall survival through spleen shrinkage and decreasing inflammatory cytokines, Jamieson concludes.

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Catriona Jamieson, MD, PhD, discusses treatment considerations for patients with myelofibrosis.

Dr. Jamieson on Treatment Considerations in Myelofibrosis 

Catriona Jamieson, MD, PhD, professor of medicine, Division of Hematology-Oncology, deputy director, Koman Family Presidential Endowed Chair in Cancer Research, chief, Division of Regenerative Medicine, deputy director, Sanford Stem Cell Clinical Center, co-leader, Hematologic Malignancies Program, director, Stem Cell Research, UC San Diego Moores Cancer Center, discusses the importance of treating patients with myelofibrosis at diagnosis.

Despite a lack of consensus across the field, starting patients on treatment when they present with myelofibrosis may be optimal, Jamieson says. Historically, patients diagnosed with myelofibrosis were monitored until disease progression because treatment options were limited and ineffective, Jamieson explains. 

However, in chronic myeloid leukemia (CML), initial treatment with TKIs at diagnosis have provided prolonged responses in most patients who can tolerate therapy, Jamieson says. Moreover, TKIs are generally well tolerated, so most patients can derive a substantial response, Jamieson adds. 

The treatment of patients with myelofibrosis appears to be in-line with the story in CML, Jamieson says. However, it is important to complete the Myeloproliferative Neoplasm Symptom Assessment Form - Total Symptom Score, and understand the patient’s level of fibrosis, presence or absence of high-risk mutations or cytogenetics, white count, platelet, and hemoglobin levels, and transfusion-dependence status, Jamieson says. Ultimately, most patients with myelofibrosis should be treated up front when these factors are considered, Jamieson concludes. 

Catriona Jamieson, MD, PhD, discusses the importance of treating patients with myelofibrosis at diagnosis.  



Dr. Jamieson on the Importance of Treating at Diagnosis in Myelofibrosis 

Catriona Jamieson, MD, PhD, the team leader for the Division of Hematology/Oncology at UC San Diego Health Moores Cancer Center, discusses symptom management in patients with myelofibrosis.

The best way to manage symptom burden for this patient population is to choose the appropriate treatment regimen, according to Jamieson. Previously, treatment options were limited for patients with myelofibrosis, and a larger focus was put on managing their quality of life vs their quantity of life, Jamieson says. However, these 2 factors are, in fact, intertwined, Jamieson notes. 

With the advent of better treatments that more effectively target the disease, both outcomes and symptoms have improved for patients, Jamieson explains. Currently, 2 FDA-approved agents are available for use in this population, but many promising agents are in the pipeline; these options will help to shift the focus in care from symptom management to disease modification for patients, Jamieson concludes.

Catriona Jamieson, MD, PhD, discusses symptom management in patients with myelofibrosis. 


Catriona Jamieson, MD, PhD, University of California San Diego

Articles

Dr. Jamieson on Treatment Considerations in Myelofibrosis

Dr. Jamieson on the Importance of Treating at Diagnosis in Myelofibrosis

Dr. Jamieson on Symptom Management in Myelofibrosis

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