How Should Myelofibrosis-Related Anemia be Managed? Global Specialists Review

People with myelofibrosis often experience decreased red blood cells (anemia). 

A consensus program led by 9 specialist hematologists was conducted between March and September 2023. The program's other members included 20 hematologists and 9 patients. The hematologists were from Europe, the United States, Canada, Australia, Israel, and India. 

One of the points from their discussion that we'll focus on in this article is how to treat myelofibrosis-related anemia. Read their insights below. 

Why Does Anemia Happen for Myelofibrosis Patients? 

Anemia is a condition characterized by a low number of mature red blood cells, which are responsible for transporting oxygen to various parts of the body. A deficiency in these cells can lead to symptoms such as fatigue.

In the case of myelofibrosis, a mutation in the stem cells (which normally develop into different types of blood cells) leads to the production of a large number of ineffective blood cells. This accumulation fills the bone marrow with scar tissue and increases chronic inflammation.

Due to this compromised state of the bone marrow, it becomes difficult for it to produce new, healthy blood cells, such as red cells. Because of this, the spleen may attempt to compensate by producing blood cells, which can cause it to enlarge.

Many strategies exist for improving low red blood cell counts. Read about the methods agreed upon in the consensus program to alleviate myelofibrosis patients’ anemia. 

When Should Anemia Treatment Start for Myelofibrosis Patients? 

Treatment for anemia that does not involve red blood cell transfusions should be started or adjusted based on specific conditions. Treatment is generally considered when hemoglobin (a protein in red blood cells that carries oxygen) falls below 10 grams per deciliter. 

How Should Anemia Be Managed if Caused by Myelofibrosis or its Treatments? 

Management of Treatment-Related Anemia 

Some myelofibrosis treatments may cause anemia. If this is the case, your doctor may recommend reducing the current therapy dose for 4 to 6 weeks to manage the anemia. 

Management of Myelofibrosis-Related Anemia 

For myelofibrosis-related anemia, your doctor may consider using a range of current and emerging treatments alone or in combination. These include JAK inhibitors like momelotinib or pacritinib, medications such as danazol, luspatercept, erythropoietin-stimulating agents (ESAs), and immunomodulatory medicines (IMiDs). 

In severe cases where other treatments have failed, surgery to remove the spleen (splenectomy) may be considered. 

One thing to note is that JAK inhibitors are the only officially FDA-approved treatment for myelofibrosis. Although the other treatments mentioned can help improve anemia for myelofibrosis patients, they are not yet FDA-approved for this specific purpose. 

See the below tables to learn more about these treatments. 

The first table shows the current anemia treatments for myelofibrosis and how they work. 

This next table shows emerging anemia treatments for myelofibrosis (those in clinical trials) and how they work. 

If you are interested in receiving one of the emerging anemia treatments for myelofibrosis in clinical trials, click the above link to review your eligibility. Some trials may be actively recruiting, whereas others are not. If you have questions about how clinical trials work in general, click here.  

Summary 

Myelofibrosis patients are often affected by anemia, a condition in which there are lower-than-normal red blood cells. Treatment options for myelofibrosis-related anemia include JAK inhibitors and emerging therapies in clinical trials. Consult with your myelofibrosis specialist to explore the best treatment strategy for you. 

If you don’t have a myelofibrosis specialist, consider adding one to your healthcare team today: Myelofibrosis Specialist Directory. 

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Sources: 

• Myelofibrosis Management in Routine Clinical Practice with a Focus on Patients with Cytopenias: Recommendations From a Global Consensus Group
• International Panel Makes Recommendations Regarding Myelofibrosis Management