Are there MPN therapies that improve platelets?

A roundtable discussion on anemia management in myeloproliferative neoplasms, featuring moderator John Mascarenhas, MD, Mount Sinai; Andrew Kuykendall, MD, Moffitt Cancer Center; and Gabriela Hobbs, MD, Massachusetts General Research Institute.

The following is an unedited transcript:

And speaking of TGF beta, we did a trial in the NPRC with Avi 200, which is a compound that is a TGF beta one three trap, and Andrew treated patients as well in the study. And what we saw there interestingly is not worsening anemia, some improvements in hemoglobin but actually most notably improvements in platelet count. And we really have no drugs.

Let me ask you guys, do we have drugs that really I mean, you mentioned, you know, sometimes the imeds at low doses, even pomalidomide, when they did the original Pamela in my study, there was like a 21% platelet, you know, improvement rate there. But do we have any drugs that actually improve platelets?

No. And I think that’s actually a great thing to bring up, because when we think about melanin, I mean, how do we use a Jak inhibitors. None of them can do that. You know, maybe it’s good at stabilizing or keeping, you know, not making things worse. But very rarely do you see an improvement.

And yet we call it so it’s.

Safer, safer, low platelets. But when it’s not it doesn’t make the platelets.

And that’s a that’s a really good point, particularly for the practitioners. Because we do have a tendency myself included, to say, you know, pacritinib is the thrombocytopenia drug, but it’s really a thrombocytopenia drug in the sense you can deliver Jak inhibition in thrombocytopenia, not necessarily that it will improve your thrombocytopenia. I have anecdotally had patients where I’ve had pretty impressive platelet cancer, but it takes time.

It does not happen quickly. And it’s usually associated with spleen reduction and probably better mobilization of platelets. So we don’t really have great drugs for thrombocytopenia, which is probably one of the most potent adverse prognostic markers kind of tracks with anemia. And when you have a really thrombocytopenia patient that the options are quite limited.