Renal function was improved when patients with primary myelofibrosis were treated with first-line ruxolitinib compared with other first-line therapeutic approaches. The findings from this retrospective study were published in Annals of Hematology.
Renal dysfunction is common in patients with primary myelofibrosis, and its etiology has often been attributed to age, comorbidities, adverse effects of treatment (eg, infections, tumor lysis syndrome), as well as complications of extramedullary hematopoiesis (EMH). However, myeloproliferative neoplasm-related glomerulopathy (MPN-RG), characterized by mesangial expansion and hypercellularity, with variable degree of features of chronic thrombotic microangiopathy, and/or intracapillary EMH, in the absence of immune-mediated glomerulonephritis, has recently been identified as the most common cause of renal dysfunction in primary myelofibrosis. Although case reports have suggested that treatment with the Janus kinase (JAK) inhibitor, ruxolitinib, may help to improve renal function in patients with primary myelofibrosis characterized by MPN-RG, the evidence supporting this effect is limited.
In this retrospective, single-institution study conducted at MD Anderson Cancer Center in Houston, baseline demographic and clinical characteristics, including estimated glomerular filtration rate (eGFR), of 100 patients with primary myelofibrosis treated with first-line ruxolitinib were matched with those of 105 patients with primary myelofibrosis receiving first-line treatment with another approach (eg, immunomodulatory drugs, small molecule inhibitors, and epigenetic modifiers).
An increase in eGFR was observed in 81% of patients receiving ruxolitinib and 58% of patients receiving non-ruxolitinib therapies (P <.001). In addition, improvement in renal function of 10% or more was observed in 73% of patients receiving ruxolinitib after a median time of 11 months and 50% of patients receiving non-ruxolitinib-based therapy after a median time of 7 months (P =.01). An independent association of use of ruxolitinib with an improvement in renal function of more than 10% was observed on multivariate analysis (P <.001).