How do I know the stage of my myelofibrosis?

How do I know the stage of my myelofibrosis?

So staging is really interesting in blood cancers because there's not really a stage. We rather think about these more in terms of, risk prognostication groups. So lower risk versus higher risk. And also we call them phases.

So there's a chronic phase where you really don't have any of the or a really low amount of, early stem cells with, that are called blasts. And then that accelerates. So to accelerated phase where you have about 10 to 19% of these blasts, and then ultimately to the blast phase or leukemia phase where there's greater than 20%, blast cells.

So it's kind of a weird paradigm, with blood cancers, but there's not really staging. We think about it in terms of what are the number of blast cells or what phase are you, and then what risk are you in terms of likelihood to progress to acute leukemia. We typically will utilize scoring systems, and use a variety of patient factors such as blood cell counts, mutational factors and other patient specific characteristics such as age, to determine a risk score for each patient.

So, multiple different scoring systems, they all use different things, but in general, we categorize patients into lower intermediate or high risk disease. And prognosis varies depending on where patients fall within that spectrum of risk. And so there are patients who have less in terms of predicted overall survival and measured in the matter of months to years. And then we have other patients, again, depending on various factors who have median survivals that are upwards of 7 to 9 years.

So it really is a spectrum of diseases. And it really does depend on the individual patient. So typically staging is based on bone marrow biopsy. So this is a bone marrow disorder. So you really can get the diagnosis and all the information from a bone marrow biopsy. In the bone marrow biopsy, we see a degree of fibrosis that a pathologist, gives us information about. And that typically ranges from MF-1, 2 to 3 three being with the most severe indicating that there's a lot of background scarring or this fibrosis.

Other factors that lead into how a clinician would treat a patient is they're having a lot of symptoms. If they have some of these abnormal cells within their peripheral blood called blasts, if they're transfusion dependent for red blood cells or platelets. And also some of these abnormal mutations that we pick up in the bone marrow. All of these are factors that way in to the staging and prognostication.