Addressing Current Challenges and Unmet Needs in Myelofibrosis
John Mascarenhas, MD, looks to the future of myelofibrosis treatment, noting present challenges and treatment strategies in development that may address those unmet needs.
Case: A 62-Year-Old Man with Myelofibrosis
Clinical Presentation:
- A 62-year-old man presented with symptoms of fatigue, night sweats, and increased bruising.
- PMH: type 2 diabetes, hypercholesteremia, and hypertension
- 1 year prior, patient had a “normal” physical and blood work.
- PCP noticed lower Hg (11 to 9.5 g/dL) and Plt (350 to 195 cells/m3)
- Patient was referred to Hem/Onc – first available appoint in 2 months.
Initial Clinical Workup and Diagnosis (Post-PCP Visit):
- Exam: fatigue and night sweats worsening; bone pain.
- Labs: RBC 3.40 x 1012/L; Hb 8.7 g/dL; Hct 36%; MCV 94fL; WBC 28.0 x 109/L; Plt 75 x 109/; LDH 330 IU/L
- Spleen: 5 cm below LCM
- Bone Marrow Fibrosis: Grade 2
- Bone Marrow Blasts: 3%
- Blood Smear: leukoerythroblastosis; 1% blasts by manual count/flow cytometry
- Molecular Analysis: JAK V617F+
- ECOG PS 2
- Diagnosis: Primary MF
Current Treatments:
- Patient was initiated on pacritinib.
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