Ruben A. Mesa, MD, discusses management strategies for patients with myeloproliferative neoplasms.
Patients with MPNs can be separated into 2 different groups: There are those who have early disease with essential thrombocythemia and polycythemia vera (PV), where the management is focused on trying to decrease the risk of thrombosis and bleeding. Management strategies for these patients include theuse of aspirin, selective use of phlebotomy for patients with PV, cytoreduction with an interplay of hydroxyurea, pegylated interferon-a2 (PEG-IFNa2; Pegasys), and JAK inhibitors, such as ruxolitinib (Jakafi).
Patients with myelofibrosis, however, have more life-threatening conditions and tend to have a higher burden of disease with splenomegaly symptoms and cytopenias. They also have a much higher risk of disease-related mortality. There is a balance between the timing of stem cell transplantation and medical therapy. The field now has 2 approved therapies, ruxolitinib and fedratinib (Inrebic), with several other JAK inhibitors following close behind in the pipeline, including momelotinib (formerly GS-0387, CYT-387) and pacritinib. Other exciting new therapies and combinations are forthcoming, as well, concludes Mesa.