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Incidence of blast phase in myelofibrosis patients according to anemia severity at ruxolitinib start and during therapy.

Authors :
Palandri F
Palumbo GA
Benevolo G
Iurlo A
Elli EM
Abruzzese E
Polverelli N
Tiribelli M
Auteri G
Tieghi A
Caocci G
Binotto G
Cavazzini F
Branzanti F
Beggiato E
Miglino M
Bosi C
Crugnola M
Bocchia M
Martino B
Pugliese N
Scaffidi L
Venturi M
Duminuco A
Isidori A
Cattaneo D
Krampera M
Pane F
Cilloni D
Semenzato G
Lemoli RM
Cuneo A
Trawinska MM
Vianelli N
Cavo M
Bonifacio M
Breccia M
Source :
Cancer [Cancer] 2024 Apr 15; Vol. 130 (8), pp. 1270-1280. Date of Electronic Publication: 2023 Dec 28.
Publication Year :
2024

Abstract

Background: Anemia is frequently present in patients with myelofibrosis (MF), and it may be exacerbated by treatment with the JAK2-inhibitor ruxolitinib (RUX). Recently, a relevant blast phase (BP) incidence has been reported in anemic MF patients unexposed to RUX.<br />Methods: The authors investigated the incidence of BP in 886 RUX-treated MF patients, included in the "RUX-MF" retrospective study.<br />Results: The BP incidence rate ratio (IRR) was 3.74 per 100 patient-years (3.74 %p-y). At therapy start, Common Terminology Criteria for Adverse Events grade 3-4 anemia (hemoglobin [Hb] <8 g/dL) and severe sex/severity-adjusted anemia (Hb <8/<9 g/dL in women/men) were present in 22.5% and 25% patients, respectively. IRR of BP was 2.34 in patients with no baseline anemia and reached respectively 4.22, 4.89, and 4.93 %p-y in patients with grade 1, 2, and 3-4 anemia. Considering the sex/severity-adjusted Hb thresholds, IRR of BP was 2.85, 4.97, and 4.89 %p-y in patients with mild/no anemia, moderate, and severe anemia. Transfusion-dependent patients had the highest IRR (5.03 %p-y). Progression-free survival at 5 years was 70%, 52%, 43%, and 27% in patients with no, grade 1, 2, and 3-4 anemia, respectively (p < .001). At 6 months, 260 of 289 patients with no baseline anemia were receiving ruxolitinib, and 9.2% had developed a grade 3-4 anemia. By 6-month landmark analysis, BP-free survival was significantly worse in patients acquiring grade 3-4 anemia (69.3% vs. 88.1% at 5 years, p < .001).<br />Conclusions: This study highlights that anemia correlates with an increased risk of evolution into BP, both when present at baseline and when acquired during RUX monotherapy. Innovative anemia therapies and disease-modifying agents are warranted in these patients.<br /> (© 2023 The Authors. Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.)

Details

Language :
English
ISSN :
1097-0142
Volume :
130
Issue :
8
Database :
MEDLINE
Journal :
Cancer
Publication Type :
Academic Journal
Accession number :
38153814
Full Text :
https://doi.org/10.1002/cncr.35156