Treatment of low-risk asymptomatic patients with PMF

Dr Chris Hillis is an assistant professor in the Division of Oncology at McMaster University and hematologist at the Juravinski Hospital and Cancer Centre.

Do you treat low-risk asymptomatic patients with primary myelofibrosis (PMF)?

Chris Hillis, MD, MSc: I think in the next 5 years we will start doing that as a matter of routine, but we are not right now.

I think the other important thing to remember is that very few patients with myelofibrosis are actually asymptomatic. If you look at the series of more than 1000 patients published by Dr Mesa and colleagues, they found that over 90% of patients with myelofibrosis were actually symptomatic, but often in a brief clinical encounter you may not pick up on all the symptoms that are occurring. That is why we always recommend to use standardized tools such as the MPN10 to try and pick up symptoms, because patients are actually way more symptomatic than we think with this condition.

But there is a population of patients who are not symptomatic and have a normal or just slightly enlarged spleen. At this time there does not appear to be any benefit, from a survival point of view, in initiating therapy in those patients. But they should be carefully monitored for developing symptoms going forward or symptomatic splenomegaly going forward because certainly at that point they would benefit from Janus kinase (JAK) inhibition.