Case 1: A 68-Year-Old Woman With Primary Myelofibrosis

Srdan Verstovsek, MD, PhD: Hello and thank you for joining us today for this Targeted Oncology® Virtual Tumor Board, which is focused on myeloproliferative neoplasms, or MPNs. In today’s presentation, my colleagues and I will review 4 clinical cases. We will discuss an individualized approach to treatment for each patient and will review key clinical trial data that affect our decisions.

I am Dr Srdan Verstovsek, from the University of Texas MD Anderson Cancer Center in Houston. Today, I’m joined by my colleagues and friends, Dr Prithviraj Bose, from the University of Texas MD Anderson here in Houston as well and Dr Rami Komrokji, from Moffitt Cancer Center in Tampa, Florida, as well as Andrew Kuykendall, from Moffitt Cancer Center in Tampa, Florida.

Thank you all for joining us today. Let’s get started with our first case.

Rami Komrakji, MD: Good morning. Our first case is a 68-year-old lady, who presents to her physician with symptoms of fatigue and abdominal pain lasting over the last 4 months. She also had some increased bruising. On physical examination, the spleen was palpable at 8 centimeters below the costal margin.

A CBC [complete blood count] showed a hemoglobin level of 9.1 g/dL; platelets, 98; and a white blood cell count of 32,000. She also was noted to have circulating peripheral blasts at 2%. She eventually undergoes a bone marrow aspirate biopsy that shows megakaryocyte proliferation and atypia, with some evidence of reticulin fibrosis. The peripheral blood smear shows leukoerythroblastosis, and the genetic testing shows JAK2 V617F mutation. This patient obviously meets the criteria for myelofibrosis. She does have the presence of the megakaryocyte proliferation on the bone marrow and the clonal markers. There are no other hematological diseases. She does have anemia, spleen, and a leukoerythroblastic picture.

Transcript edited for clarity.