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Treatment Options and Transfusion for Myelofibrosis After Standard Therapy

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Published on February 24, 2015

At our MPN Town meeting in Denver, an audience member asked the experts about myelofibrosis (MF) options beyond the standard treatment.  The expert panel described additional treatment options for those with MF and also addressed transfusion, explaining why it’s done and the effects of multiple transfusions.

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Transcript | Treatment Options and Transfusion for Myelofibrosis After Standard Therapy

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That's how you’ll get care that's most appropriate for you.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Audience Member:

Dr. Daver:

Actually, that's a very good question.  This is a question I actually get almost two or three times every day in clinic.  We see a lot of the leukemia and MPN patients.  So, one, what comes next.  So I think today I would say if your disease is refractory to Hydrea, phlebotomy and Revlimid or thalidomide, then ruxolitinib (Jakafi®) would be a good option depending on if you have the specific type of MF and your symptoms are more from spleen, night sweat, fatigue point of view.  After that, you know, I would consider clinical trial. 

I think that is the perfect time—or even before that if your physician felt like clinic—there are many clinical trials that are available. 

And then if you are below 70, stem cell transplant is an open option depending on each patient.  We don't frequently send patients with MPN, but if you are really refractory to three or four agents I do think that stem cell transplant has a very good role if they can find a donor and the logistics work out. 

You know, besides that I don't think that there are too many other treatments available at this time. 

What was the second part of your question? 

Audience Member:

What's the problem of becoming transfusion dependent? 

Dr. Daver:

Yeah.  So getting multiple transfusions, so we don't see iron overload that is clinically significant in leukemia patients almost ever, and part of that is related to the disease itself.  When you have a disease such as hemochromatosis where you retain a lot of iron or if you're getting transfusions for non-leukemic condition, your body, you know, retains that iron.

But when you are having a cell turnover of about eight to 10 times, your body uses most of the iron that is given from phlebotomy to produce cells.  So I really am not a big—and at MD Anderson—we're not very big proponents of using iron chelators unless we're seeing evidence of liver, cardiac or kidney damage and a ferritin usually above 5,000.  So in general I tell my patients we'll check your ferritin every year or so. We'll check your liver enzymes, kidney enzymes, cardiac function with EKG. 

If those are fine, I would not start iron chelation because a lot of these chelators, especially the oral ones like deferasirox (EXJADE®), they have their own set of side effects.  You know, you can get kidney problems, hearing.  So it's not something frequent.  I haven't had a patient, for example, in the last year that I have had to start iron chelation on.  I don't know if Dr. Di Bella has a different…

Dr. Di Bella:

…no, I think in general that's true. 

There is a disease group that's related to the M—myeloproliferative disorders called the myelodysplastic disorders, MDS, and there transfusion dependency is a big part of the clinical progress of the disease. And we do see a benefit from trying to remove iron with these oral agents, but we haven't seen that with MPN. 

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.