Updates in the Management of Myeloproliferative Neoplasms - Episode 11

Utilization of Ruxolitinib for Polycythemia Vera

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Harry P. Erba, MD, PhD: When I think about PV patients and controlling their hematocrit and splenic volume, which is not a problem in many patients with PV and is why the RESPONSE-2 trial was done, the other thing I’m focusing on is quality of life. This disease affects their quality of life in many ways with other symptomatology related to this myeloproliferative neoplasm.

I’d like Jamile to comment on this. What has been your clinical experience with using ruxolitinib? Quite frankly, do you ever switch to ruxolitinib for something other than hematologic control or splenic volume reduction?

Jamile M. Shammo, MD, FASCP, FACP: I’m glad you brought this up because, as I was hearing everyone talk, I’ve been thinking about the last few patients I ended up switching to ruxolitinib. It wasn’t because of a lack of hematologic optimization with cytoreduction that they were on before hydroxyurea, namely. It’s because they developed night sweats and pruritus that was difficult to control, and they weren’t able to sleep. Imagine if you have 1 night after the other of not being able to sleep because of pruritus that didn’t respond to any other measures.

That was the impetus for a subset of my patients who had PV: to improve their quality of life. My experience mirrors the clinical trial data. Ruben is here, so he can speak to that because there was a 50% reduction in half the patients. Close to half the patients had greater to or equal to 50% reduction in their constitutional symptoms. It’s very similar to what I have experienced.

Harry P. Erba, MD, PhD: This is an important point, because what we’re talking about is a bit outside the label of where the drug has been approved based on splenic volume reduction and improvement in phlebotomy or hematocrit control. Ruben, you have been involved in a symptom control study in PV. What can you tell us about the quality of life for these patients who are on ruxolitinib?

Ruben A. Mesa, MD, FACP: Without question, it has been significantly favorably impacted both in aggregate and looking at all the symptoms together: a total symptom score model and with individual symptoms. In PV, there are certain symptoms that are particularly difficult: pruritus perhaps being 1 of the most difficult to live with on a chronic basis, many of whom were quite refractory with night sweats, spleen-related symptoms, and others.

It is helpful with that kind of a target symptom view in terms of the most problematic symptom and quality of life, as well as in aggregate. My colleague Robyn Scherber and I presented at last year’s ASH Meeting, showing how centrally important the symptoms were to the MPN patient’s quality of life. You can imagine, if you were itching 24-7, how disruptive that would be for your quality of life. It can be a difficult thing to live with.