Dr. Jamieson on the Importance of Treating at Diagnosis 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.