A 62-Year-Old Man with Myelofibrosis : Episode 4
JAK Inhibitors in Myelofibrosis
John Mascarenhas, MD, reviews JAK2 inhibitor options for patients with myelofibrosis, including pacritinib, ruxolitinib, and momelotinib.
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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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