Hematologic Oncology | Ruben A Mesa, MD

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Myeloproliferative Neoplasms Update — Part 1: Our interview with Dr Mesa highlights the following topics and cases from his practice:

  • Molecular pathogenesis of myeloproliferative neoplasms (MPNs) (00:00)
  • Cytokine activation and its association with the distinct symptomatology of MPNs (3:42)
  • Targeting the JAK-STAT pathway in myelofibrosis (MF) and polycythemia vera (PV) (5:19)
  • Case:A 66-year-old man with symptomatic primary MF with a CALR mutation receives ruxolitinib (9:05)
  • Clinical parameters to evaluate when considering treatment with ruxolitinib (11:23)
  • Discussing the complexities of allogeneic transplant with patients considering this intervention (16:05)
  • Clinical outcomes and complication rates for younger versus older patients undergoing transplant (16:46)
  • Counseling patients regarding the efficacy and side-effect profile of ruxolitinib (20:41)
  • Symptom improvement with ruxolitinib; dosing for patients with MF (24:14)
  • Management of anemia associated with ruxolitinib treatment (26:27)
  • Approach to dosing ruxolitinib for patients with MF and cytopenias (29:58)
  • Consideration of ruxolitinib treatment holidays and therapy reinitiation for patients with increased splenomegaly (32:22)
  • Treatment options for patients with MF and disease progression on ruxolitinib (36:20)
  • Clonal evolution and outcomes in MF after ruxolitinib discontinuation (38:53)
  • Therapeutic options for patients who experience disease progression on ruxolitinib (41:06)
  • Activity, tolerability and ongoing investigation of novel JAK inhibitors pacritinib, momelotinib and fedratinib in MF (44:36)
  • FDA clinical hold on fedratinib due to possible occurrences of Wernicke encephalopathy in patients on the JAKARTA-1 trial and recent lift of the hold (47:46)
  • Ongoing investigation of fedratinib in MF (48:56)
  • Clinical experience with pacritinib, momelotinib and fedratinib (52:46)
  • Toward identifying molecular predictors of response to pacritinib, momelotinib and fedratinib (53:59)
  • Case: A 64-year-old woman with ruxolitinib-refractory MF receives fedratinib on the Phase II JAKARTA-2 trial (55:51)
  • Therapeutic approach to MF that progresses to acute myeloid leukemia (59:26)
  • Investigation of the novel Bcl-2 inhibitor navitoclax in combination with ruxolitinib for patients with MF (1:2:42)
  • Clinical manifestations and treatment of PV (1:3:12)
  • Case: A 56-year-old woman with high-risk PV and an inadequate response to hydroxyurea receives ruxolitinib (1:5:53)
  • Risk stratification and treatment for patients with essential thrombocythemia (ET) (1:8:26)

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