Timing of Ruxolitinib Initiation in Intermediate- or High-Risk Myelofibrosis
Dr. Bose discusses when he typically initiates ruxolitinib for his intermediate- or high-risk myelofibrosis patients.
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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