Evaluating the Correlation Between Anemia and Blast Phase Evolution Risk Among Patients With Myelofibrosis

Francesca Palandri, MD, PhD, IRCCS Azienda Ospedaliero-Universitaria di Bologna, evaluates the correlation between anemia and an increased risk of evolution into blast phase among patients with ruxolitinib-treated myelofibrosis (MF), both when present at baseline and when acquired during ruxolitinib treatment. 

Dr Palandri noted that study findings reveal a key therapeutic goal to mitigate the development of anemia during Janus kinase (JAK) inhibitor therapy among this patient population. 

Oncology Learning Network: What was the aim of this study? 

Our study wanted to investigate whether anemia may have an impact on clinical outcomes and [the] probability [of] progression to acute leukemia in patient[s] treated with ruxolitinib immunotherapy.

What were the methods and results of this study? What are the implications that can be drawn from each of the findings? 

We retrospectively analyzed almost 900 MF patients who received ruxolitinib in a real-world setting. Our study collected 3 main results. First, ruxolitinib is widely used in patients with anemia. Specifically, severe anemia is present at baseline in around 20% of patients, [and] mild anemia in 45% of patients. Only 1/3 of the patients have no anemia at the start of treatment. So, the first key message is the management of anemia in patients requiring JAK inhibitor therapy for splenomegaly symptoms is a frequent clinical issue.

Second, we observe that the incidence rate of blast phase is lower in patients with no anemia, around 2% of patient years, and it is significantly higher in all the patients with anemia around 4 to 5% patient years regardless of the severity of anemia. So, the second message is the probability of having an acute transformation is high, even in patients with mild non-transfusion-dependent anemia. These patients deserve special medical attention and possibly a different frontline treatment strategy. 

Finally, we observed that around 10% of the patients with no baseline anemia acquired severe anemia after 6 months of ruxolitinib immunotherapy. These patients [are] at a significantly higher risk of leukemia transformation compared to patients with no or mild anemia at 6 months. Therefore, this is the third message of the paper. 

How have these results impacted your future goals for the treatment of myelofibrosis? 

I believe that avoiding the development of severe anemia during JAK inhibitor therapy must also be a therapeutic goal for our future.

Source: 

Palandri F, Palumbo GA, Benevolo G, et al. Incidence of blast phase in myelofibrosis patients according to anemia severity at ruxolitinib start and during therapy. Cancer. Published online December 28, 2023. doi:10.1002/cncr.35156