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Novel Concepts of Treatment for Patients with Myelofibrosis and Related Neoplasms

Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Cancers 2020, 12(10), 2891; https://doi.org/10.3390/cancers12102891
Received: 30 August 2020 / Revised: 30 September 2020 / Accepted: 1 October 2020 / Published: 9 October 2020
(This article belongs to the Special Issue New Insights into Myeloproliferative Neoplasms)
Myelofibrosis (MF) is an advanced form of a group of rare, related bone marrow cancers termed myeloproliferative neoplasms (MPNs). Some patients develop myelofibrosis from the outset, while in others, it occurs as a complication of the more indolent MPNs, polycythemia vera (PV) or essential thrombocythemia (ET). Patients with PV or ET who require drug treatment are typically treated with the chemotherapy drug hydroxyurea, while in MF, the targeted therapies termed Janus kinase (JAK) inhibitors form the mainstay of treatment. However, these and other drugs (e.g., interferons) have important limitations. No drug has been shown to reliably prevent the progression of PV or ET to MF or transformation of MPNs to acute myeloid leukemia. In PV, it is not conclusively known if JAK inhibitors reduce the risk of blood clots, and in MF, these drugs do not improve low blood counts. New approaches to treating MF and related MPNs are, therefore, necessary.
Janus kinase (JAK) inhibition forms the cornerstone of the treatment of myelofibrosis (MF), and the JAK inhibitor ruxolitinib is often used as a second-line agent in patients with polycythemia vera (PV) who fail hydroxyurea (HU). In addition, ruxolitinib continues to be studied in patients with essential thrombocythemia (ET). The benefits of JAK inhibition in terms of splenomegaly and symptoms in patients with MF are undeniable, and ruxolitinib prolongs the survival of persons with higher risk MF. Despite this, however, “disease-modifying” effects of JAK inhibitors in MF, i.e., bone marrow fibrosis and mutant allele burden reduction, are limited. Similarly, in HU-resistant/intolerant PV, while ruxolitinib provides excellent control of the hematocrit, symptoms and splenomegaly, reduction in the rate of thromboembolic events has not been convincingly demonstrated. Furthermore, JAK inhibitors do not prevent disease evolution to MF or acute myeloid leukemia (AML). Frontline cytoreductive therapy for PV generally comprises HU and interferons, which have their own limitations. Numerous novel agents, representing diverse mechanisms of action, are in development for the treatment of these three classic myeloproliferative neoplasms (MPNs). JAK inhibitor-based combinations, all of which are currently under study for MF, have been covered elsewhere in this issue. In this article, we focus on agents that have been studied as monotherapy in patients with MF, generally after JAK inhibitor resistance/intolerance, as well as several novel compounds in development for PV/ET. View Full-Text
Keywords: imetelstat; PRM-151; KRT-232; CPI-0610; ropeginterferon alfa-2b imetelstat; PRM-151; KRT-232; CPI-0610; ropeginterferon alfa-2b
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MDPI and ACS Style

Bose, P.; Masarova, L.; Verstovsek, S. Novel Concepts of Treatment for Patients with Myelofibrosis and Related Neoplasms. Cancers 2020, 12, 2891. https://doi.org/10.3390/cancers12102891

AMA Style

Bose P, Masarova L, Verstovsek S. Novel Concepts of Treatment for Patients with Myelofibrosis and Related Neoplasms. Cancers. 2020; 12(10):2891. https://doi.org/10.3390/cancers12102891

Chicago/Turabian Style

Bose, Prithviraj, Lucia Masarova, and Srdan Verstovsek. 2020. "Novel Concepts of Treatment for Patients with Myelofibrosis and Related Neoplasms" Cancers 12, no. 10: 2891. https://doi.org/10.3390/cancers12102891

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