From the Research
Management of Primary Myelofibrosis (PMF) with Transfusion-Dependent Anemia
The management of a 76-year-old man with primary myelofibrosis (PMF) and transfusion-dependent anemia involves several considerations, including:
- Palliative care to improve quality of life, as the treatment of PMF remains essentially palliative 1
- Conventional modalities such as oral cytolytic drugs, androgens or erythropoietin for anemia, and splenectomy in selected patients 1
- Newer therapies, including antiangiogenic and immunomodulatory drugs, tyrosine kinase inhibitors, and JAK2 inhibitors, which have shown efficacy in improving anemia and thrombocytopenia 1, 2
- Iron chelation therapy to decrease the risk of haemosiderosis associated organ dysfunction in patients with transfusion-dependent anemia 3
Treatment Options for Transfusion-Dependent Anemia
Treatment options for transfusion-dependent anemia in PMF patients include:
- JAK inhibitors, such as ruxolitinib, which have been shown to improve symptoms and quality of life 4
- Combination therapy with fedratinib and luspatercept, which has been shown to achieve transfusion independence in some patients 2
- Iron chelation therapy to reduce iron overload and improve survival 3
Considerations for Older Patients with PMF
When managing older patients with PMF, it is essential to consider:
- Comprehensive geriatric assessments to evaluate frailty, polypharmacy, and drug-drug interactions 5
- Holistic management, including interventions for concurrent illnesses, nutritional issues, psychological concerns, and social/economic aspects 5
- The potential benefits and risks of different treatment options, including palliative care and newer therapies 1, 5, 4