Dr. Verstovsek on Addressing Anemia in Patients with Myelofibrosis

Srdan Verstovsek, MD, PhD, professor, director, Hanns A. Pielenz Clinical Research Center for Myeloproliferative Neoplasms, chief, Section for Myeloproliferative Neoplasms, Department of Leukemia, The University of Texas MD Anderson Cancer Center, discusses addressing anemia in patients with myelofibrosis.

Approximately 40%-50% of patients with myelofibrosis present with anemia at the time of diagnosis, which is defined as hemoglobin levels less than 10 g/dL, Verstovsek says. Additionally, a proportion of these patients require red blood cell (RBC) transfusions, and a smaller subset of patients are considered transfusions dependent, since they require multiple transfusions early following diagnosis, Verstovsek adds.

JAK inhibitors, such as ruxolitinib (Jakafi) and fedratinib (Inrebic), are often used for patients with myelofibrosis who are symptomatic or have spleen symptoms. However, JAK inhibitors have about a 50% chance of worsening anemia in these patients, Verstovsek notes. At the end of frontline therapy with ruxolitinib or fedratinib, approximately 70%-80% of patients with myelofibrosis are anemic, and about half of those patients require transfusions, Verstovsek explains.

The presence of anemia and the need for transfusions create a lower quality of life for these patients, Verstovsek says. Additionally, transfusions can create iron overload in patients, since they cannot properly secrete all of the iron added through transfusions, Verstovsek concludes.