Neil Dunavin, MD, MS, assistant professor of medicine, School of Medicine, University of California, San Francisco (UCSF), UCSF Helen Diller Family Comprehensive Cancer Center, discusses ongoing research on therapies for patients with myelofibrosis.

At the 2019 ASH Annual Meeting, novel combination therapies with ruxolitinib (Jakafi) generated excitement, says Dunavin, who hopes that these combinations move on to later-phase studies. However, no large, practice-changing phase III studies in myelofibrosis were presented at the meeting, according to Dunavin.

Luspatercept-aamt (Reblozyl), a red blood cell stimulatory agent, is approved for the treatment of anemia in adult patients with beta thalassemia who require regular red blood cell transfusions, based on data from the BELIEVE trial (NCT02604433). Results from the trial showed that treatment with luspatercept-aamt resulted in significant reductions in red blood cell transfusion burden in this patient population.

In the future, the agent might also receive approval for use in patients with myelodysplastic syndrome with ring sideroblasts who need more red blood cells, says Dunavin. The drug is given to patients with isolated anemia, which is a significant problem in patients with myelofibrosis. As such, Dunavin is interested to see whether luspatercept-aamt can be given to patients with myelofibrosis as well.

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Neil Dunavin, MD, MS, discusses ongoing research on therapies for patients with myelofibrosis.

Dr. Dunavin on Ongoing Research for Myelofibrosis Treatments

Neil Dunavin, MD, MS, assistant professor of medicine, School of Medicine, University of California, San Francisco (UCSF), UCSF Helen Diller Family Comprehensive Cancer Center, discusses frontline treatment in myelofibrosis.

Myelofibrosis is a highly symptomatic disease, explains Dunavin. Patients with myelofibrosis may have low blood counts that require transfusion, fatigue, sweats, and enlarged spleens.

Ruxolitinib (Jakafi) is the current frontline standard of care for patients with myelofibrosis who have adequate blood counts, says Dunavin. In November 2011, the oral JAK1/2 inhibitor became the first drug to receive regulatory approval for the treatment of patients with myelofibrosis.

Neil Dunavin, MD, MS, discusses frontline treatment in myelofibrosis.

Dr. Dunavin on Frontline Treatment in Myelofibrosis

Neil Dunavin, MD, MS, assistant professor of medicine, School of Medicine, University of California, San Francisco (UCSF), UCSF Helen Diller Family Comprehensive Cancer Center, discusses treatment considerations in myelofibrosis.

Over the past couple years, several scoring systems have been developed to aid in establishing the prognosis of patients, says Dunavin. The scoring system characterizes the patient’s risk, which can help inform their outcome and the need for more aggressive therapy up front.

After the patient’s risk of disease has been established, the patient’s symptom burden should be evaluated, says Dunavin. According to the patient’s disease burden, an appropriate therapy can be recommended or subsequent treatment plans can be adjusted, if necessary.

Notably, allogeneic stem cell transplant is the only curative treatment in myelofibrosis; however, not all patients are eligible to undergo the procedure. The decision of whether to proceed with transplant or not should be based on age and patient comorbidities, concludes Dunavin.

Neil Dunavin, MD, MS

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Dr. Dunavin on Ongoing Research for Myelofibrosis Treatments

Dr. Dunavin on Frontline Treatment in Myelofibrosis

Dr. Dunavin on Treatment Considerations in Myelofibrosis