Ruchi J. Desai, MD, is an assistant professor in the Division of Hematology, Oncology, and Palliative Care at the Virginia Commonwealth University (VCU) School of Medicine as well as a hematologist/oncologist in the Department of Internal Medicine at VCU Health.

Dr Desai on Future Research Directions in MPN and Other Hematologic Malignancies 

“Gone are the days of [exclusively] treating patients with hematologic malignancies with chemotherapy. We really need to understand the microenvironment and the signaling cascades through which driver mutations work.”

Ruchi J. Desai, MD, an assistant professor in the Division of Hematology, Oncology, and Palliative Care at the Virginia Commonwealth University (VCU) School of Medicine as well as a hematologist/oncologist in the Department of Internal Medicine at VCU Health, discussed future research areas of interest in myeloproliferative neoplasms (MPNs) and other hematologic malignancies.

Desai emphasized that the era of treating patients with hematologic malignancies exclusively with chemotherapy is drawing to a close. Investigators need to perform further research to understand the microenvironment and the signaling cascades through which driver mutations function, she added. Additional pragmatic treatment combinations are also needed in order to minimize therapeutic toxicity and better induce remissions for patients, she said.

As knowledge in the field continues to grow in terms of understanding disease biology, better definitions of disease remission and cure will also be developed, Desai said. These definitions are currently lacking in many disease states.

 State of the Science Summit on hematologic malignancies, which took place on October 15, 2025, Desai discussed JAK inhibitors for the treatment of patients with MPNs, specifically myelofibrosis and of polycythemia vera (PV). During her presentation, she outlined findings from several studies, including the phase 3 RESPONSE trial (NCT01243944) of ruxolitinib (Jakafi) in patients with PV, the phase 2 REALISE study (NCT02966353) of ruxolitinib in patients with myelofibrosis and anemia, and the phase 2 MAJIC-PV study (NCT01243944) of ruxolitinib vs best available therapy in patients with PV. She also discussed findings with other JAK inhibitors for the treatment of patients with MPNs, such as momelotinib (Ojjaara) and fedratinib (Inrebic).

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Ruchi J. Desai, MD, discusses future research directions in MPN and other hematologic malignancies.

Dr Desai on the Use of JAK Inhibitors in Myeloproliferative Neoplasms

“There’s been a lot of work in lymphoid malignancies as well as other myeloid malignancies where targeted agents towards driver mutations, with the addition of other apoptosis-inducing agents or other disease modifying agents, have led to good hematologic responses, as well as pathologic and molecular responses.”

Ruchi J. Desai, MD, an assistant professor in the Division of Hematology, Oncology, and Palliative Care at the Virginia Commonwealth University (VCU) School of Medicine as well as a hematologist/oncologist in the Department of Internal Medicine at VCU Health, discussed the use of JAK inhibitors for the treatment of patients with myeloproliferative neoplasms (MPNs).

 State of the Science Summitt on hematologic malignancies, which took place on October 15, 2025, Desai discussed the present standing and potential future of JAK inhibitors in patients with MPNs, specifically myelofibrosis and of polycythemia vera (PV). There has been a lot of research in lymphoid malignancies as well as other myeloid malignancies with agents directed towards driver mutations in combination with other apoptosis-inducing agents or disease modifying agents which have led to notable hematologic, pathologic, and molecular responses, she noted.

Unfortunately, unlike in other disease areas, inhibiting driver mutations in patients with myelofibrosis with JAK inhibitors has not been shown to alter the natural history of the disease, Desai explained. In patients with PV, JAK inhibitor treatment has been linked to molecular responses and improved event-free survival outcomes, but it has not been shown to have an overall survival benefit, she added.

Similarly, in patients with myelofibrosis, JAK inhibitors have been shown to reduce morbidity and potentially mortality, but these agents do not typically produce pathologic or molecular remissions, she added. Although targeted therapies are available for the treatment of patients with myelofibrosis and PV, a cure for these patients using medications alone remains elusive, she concluded.

Ruchi J. Desai, MD, discusses the current standing of JAK inhibitors in the treatment landscape of myeloproliferative neoplasms.

Dr Desai on Notable Ongoing Studies in Myeloproliferative Neoplasms

“I’m interested to see [findings with] unique combinations between agents, such as luspatercept, momelotinib, and pacritinib, particularly in patients with cytopenic myelofibrosis.”

Ruchi J. Desai, MD, an assistant professor in the Division of Hematology, Oncology, and Palliative Care at the Virginia Commonwealth University (VCU) School of Medicine as well as a hematologist/oncologist in the Department of Internal Medicine at VCU Health, discussed notable ongoing studies that are examining agents for the treatment of patinets with myeloproliferative neoplasms.

Desai began by noting that she is anticipating findings from the phase 3 SENTRY trial (NCT04562389), which is evaluating selinexor (Xpovio) in combination with ruxolitinib (Jakafi) for the treatment of patients with myelofibrosis who have not received a JAK inhibitor. The study randomly assigned patients 2:1 to receive selinexor in combination with ruxolitinib or ruxolitinib monotherapy.The coprimary end points are spleen volume response rate of at least 35% at week 24 and the average change in absolute total symptom score over 24 weeks relative to baseline. In September 2025, Karyopharm Therapeutic announced that enrollment to SENTRY was completed and topline data from the study were expected to be shared in March 2026.

Desai noted that she is looking forward to seeing unique combinations containing agents such as luspatercept

aamt (Reblozyl), momelotinib (Ojjaara), and pacritinib (Vonjo) be further evaluated in clinical trials, especially in patient with cytopenic myelofibrosis. Although early, data on the use of interferons for the treatment of patients with myelofibrosis are also of interest, she added.

In the polycythemia vera (PV) space, Desai explained that she is looking forward to seeing data with rusfertide-containing combination regimens. She also hopes to see additional findings with silencing RNA therapies in PV. These agents have the potential to help patients avoid phlebotomy and maintain acceptable hematocrit levels, she concluded.

Ruchi J. Desai, MD, discusses several notable ongoing studies examining agents for the treatment of patients with myeloproliferative neoplasms.

Dr Desai on the Treatment Landscape of Polycythemia Vera

“One of the biggest challenges [in treating patients with polycythemia vera] has been [elucidating] how to modify the underlying pathobiology of the disease.”

Ruchi J. Desai, MD, an assistant professor in the Division of Hematology, Oncology, and Palliative Care at the Virginia Commonwealth University (VCU) School of Medicine as well as a hematologist/oncologist in the Department of Internal Medicine at VCU Health, discussed the present treatment landscape of polycythemia vera (PV) and the remaining unmet needs in the space.

Desai began by noting that PV has historically been a disease which has led to significant symptom morbidity for patients. PV also carries risks for thrombosis, with a greater risk for arterial thrombosis compared with venous thrombosis, she added. Thus, treatment approaches have generally been focused on reducing this symptom morbidity, mainly through keeping hematocrit levels low via approaches such as phlebotomy and/or cytoreductive agents, she explained.

One of the biggest ongoing challenges in treating patients with PV has been determining how to modify the underlying pathobiology of the disease, Desai said. There has never been a true proven treatment approach that has been able to achieve this disease modification, she noted. The closest agent that has been able to modify the disease biology of PV is ropeginterferon alfa-2b-njft (Besremi), she explained.

Clinical studies of ropeginterferon alfa demonstrated a reduction in the JAK2 allele burden, which may be correlated to patients achieving a molecular and pathologic remission, Desai explained. However, what constitutes pathologic and molecular remissions in PV is not well defined, representing an unmet need in the field, she concluded.

approved by the FDA for the treatment of patients with PV in November 2021

. The regulatory decision was supported by data from the phase 3 PROUD-PV (NCT01949805) and CONTINUATION-PV (NCT02218047) studies which demonstrated that patients who received ropeginterferon alfaachieved a complete hematological response at a rate of 61% after 7.5 years of therapy.

Ruchi J. Desai, MD, discusses the treatment landscape of polycythemia vera and unmet needs in the space.

Ruchi J. Desai, MD

Articles

Dr Desai on Future Research Directions in MPN and Other Hematologic Malignancies

Dr Desai on the Use of JAK Inhibitors in Myeloproliferative Neoplasms

Dr Desai on Notable Ongoing Studies in Myeloproliferative Neoplasms

Dr Desai on the Treatment Landscape of Polycythemia Vera