Dr. Rampal on the Importance of Genomic Testing in Myelofibrosis

Raajit K. Rampal, MD, PhD, hematologic oncologist, Memorial Sloan Kettering Cancer Center, discusses the importance of genomic testing in myelofibrosis.

The JAK inhibitors ruxolitinib (Jakafi) and fedratinib (Inrebic) have transformed the treatment paradigm of myelofibrosis, Rampal says. However, these therapies are not curative and most patients who start on ruxolitinib fail treatment within 3 to 5 years.

Genomic testing can provide critical insight into a patient’s disease, Rampal explains. For example, patients who harbor 3 or more mutations or specific mutations, such as ASXL1 or DNMT3A, are less likely to derive sustained responses from JAK inhibitor therapy.

Regardless of genomic information, JAK inhibitors should be given to patients with myelofibrosis to reduce splenomegaly and control symptoms, Rampal adds. However, genomic information can predict the degree to which a patient may benefit from treatment. For example, if a patient is likely to have a short-term response to a JAK inhibitor, a transplant or clinical trial should be considered, Rampal concludes.