Timing of Ruxolitinib Initiation in Intermediate- or High-Risk Myelofibrosis

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Dr. Bose discusses when he typically initiates ruxolitinib for his intermediate- or high-risk myelofibrosis patients.

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      Case: Intermediate-Risk Primary Myelofibrosis in a 68-Year-Old Woman

      Clinical Presentation:

      • A 68-year-old woman presented to her physician with symptoms of mild fatigue.
      • Spleen was palpable 6-7 cm below the left costal margin.

      PM: No known comorbidities

      Initial Clinical Workup and Diagnosis:

      • NGS Testing: JAK2 V617F mutation
      • Karyotype: 46XX
      • BM biopsy: megakaryocyte proliferation and atypia with evidence of reticulin fibrosis
      • Blood smear: leukoerythroblastosis
      • Diagnosis: Primary myelofibrosis
      • Risk:
        • DIPSS: Intermediate-2
        • Mipss70: Intermediate risk
      • Lab Values
        • RBC 3.40 x 1012/L
        • Hgb 9.7 g/dL
        • HCT 32.3%
        • MCV 94 fL
        • WBC 23.0 x 109/L
        • PLT 450 x 109/L
        • PB Blasts <1%

      Initial Treatments:

      • Initiated on ruxolitinib.
        • The patient was not interested in transplant.

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