Treatment Sequencing in Myelofibrosis

Opinion
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Dr Oh provides clinical insights on sequencing therapies for patients with myelofibrosis and discusses the sequential use of JAK inhibitors.

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      Case: A 63-Year-Old Man with Myelofibrosis

      Clinical Presentation:

      • A 63-year-old man recently diagnosed with primary MF and initiated on 10 mg BID ruxolitinib.
      • PMH: type 2 diabetes, hypercholesteremia, and hypertension, squamous cell carcinoma (SCC)

      Follow up and Clinical Workup at 3 Months:

      • Exam: night sweats improved.
      • Labs: Hb 7.8 g/dL; Plt 80 x 109/L (previously 135k) stabilized.
      • Some spleen reduction.
      • Patient receives ~1 unit RBC per month.

      Follow up and Clinical Workup at 6 Months:

      • Patient reports complaints of fatigue and abdominal pain.
      • Labs: Plt 55 x 109/L; Hgb 6.8 g/dL
      • Patient now receives 2 units RBC per month.
      • Experienced recurrence of SCC.

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