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:
Let’s say we’ve got a patient on a Jak inhibitor. What are some of the emerging therapies that you could add on to the Jak inhibitor, for example, to alleviate anemia?
Yeah. So the first thing I would say is, you know, older therapies we’re talking about we talked about ESR a little bit already. Dan, is all the data for ESR and Danny’s all is pretty pretty weak in general. I mean I think a lot of it’s more feasibility, like, you can do this, and you can access these medications and they’re not extremely toxic.
So, but I would say the efficacy data for those agents is pretty limited. And so we’re certainly trying to do, you know, a little bit better than that. And I think loose powder slept well, not approved for myelofibrosis right now. Certainly has data in the phase two setting suggesting pretty robust responses in a subset of patients, especially those who are transfusion dependent on rock solid and been.
Yeah, no, I agree, I mean, I think if I have a patient that is on the Jak inhibitor and they develop anemia, some patients, it’s really hard to get them off of their rock solid and especially those symptoms, those patients that are that are have really significant, significant symptoms. Those are still patients where I think it’s still pretty reasonable to add other drugs to them.
But like Andrew said, you know, there is modest response. So it’s good to know that we can at least sequence them. And I think, generally speaking, we don’t know what the optimal way of sequencing these patients.
I like using like two different examples. You have someone on rocks enjoying spleen and symptom benefit, but that hemoglobin is going down there maybe needing a transfusion every once in a while. That’s one scenario, maybe the other scenarios. You have someone on rocks. Spleen is still pretty big. They’re still having some symptomatology and their hemoglobin is going down.
Gabby, I’ll start with you. Where would you maybe add something to rocks like loose powder, sup versus switch to mammals and procreate?
So that first patient you described, I think that that one sort of depends on what’s going on. But I would be more inclined to add something to that patient because they are doing pretty well, especially if they’re very symptomatic before, but certainly have a low threshold to switch them over to move them a lot. Nim, if I don’t see an improvement relatively quickly, the second patient you describe to somebody that concerns me a little bit more, and where I feel like I definitely would not want to keep that person under excellent name.
If I feel like I’m dose limit, you know, have dose limiting anemia that I can’t improve them, you know, I can’t improve on symptoms anymore and they’re developing more anemia. So for that patient I’d be willing to switch them over. But also being very aware of the fact that progresses when I’m on a something to also be concerned about.
And so if I had if I have a clinical trial available to either added on or do something and, you know, novel mechanism of action, I would do that. And otherwise, I think starting to think about transplant pretty seriously, if I hadn’t been thinking about that before, would be really important at that time.
