Laboratory/Symptom Monitoring

Weekly CBC monitoring is reasonable when starting a new therapy, especially in light of the patient’s hemoglobin levels and the development of thrombocytopenia within the first month of treatment. 

Anemia is an expected dose-dependent side effect of ruxolitinib, and Mr M required blood transfusions twice monthly during the first 2 months of therapy. An important note is that the development of anemia does not limit the efficacy of ruxolitinib, and patients still feel better despite developing a transient, therapy-related anemia. Improvement often occurs after an initial decline in hemoglobin levels, and patients may no longer need transfusions.Once a patient is stable, reducing follow-up to once monthly and then every 3 months is generally acceptable. 

Mr M continues to have symptomatic improvement and stable laboratory values with infrequent packed red blood cell transfusions. His spleen has decreased in size considerably. He continues to follow-up with pulmonology at this time; however, no interventions have been initiated for the previously diagnosed pulmonary hypertension. We will continue a team approach to managing Mr M’s treatment.

References 

1. Arber DA, Orazi A, Hasserjian R, et al. The 2016 revision to the Whole Health Organization classification of myeloid neoplasms and acute leukemiaBlood. 2016;127(20):2391-2405.

2. Rumi E, Cazzola M, Diagnosis, risk stratification, and response evaluation in classical myeloproliferative neoplasmsBlood. 2017;129(6):680-692.

3. Verstovsek S, Mesa RA, Gotlib J, et al. A double-blind, placebo-controlled trial of ruxolitinib for myelofibrosisN Engl J Med. 2012;366(9):799-807.

4. Jakafi® [package insert]. Wilmington, DE: Incyte Corporation; 2016.

5. Verstovsek S, Mesa RA, Gotlib RS, et al; COMFORT-I investigators. Results of COMFORT-I, a randomized double-blind phase III trial of JAK 1/2 inhibitor INCB18424 (424) versus placebo (PB) for patients with myelofibrosis (MF)J Clin Oncol.2011;29(suppl):Abstr 6500.