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MPN Workshop of the Carolinas 2025 | The value of early initiation of ruxolitinib treatment in patients with myelofibrosis
Ruben Mesa, MD, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, emphasizes the importance of initiating ruxolitinib treatment as early as possible in patients with myelofibrosis (MF), except in those with low-risk disease and a low symptom burden. Dr Mesa notes that earlier treatment is associated with improved spleen size reduction, decreased symptoms, and a benefit in progression-free survival (PFS). These improvements are more pronounced in patients with less advanced disease, suggesting early treatment initiation should be considered. This interview took place at the 2nd Annual MPN Workshop of the Carolinas, held in Charlotte, NC.
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Transcript
I think ruxolitinib in myelofibrosis really should be initiated as early as possible in probably the vast majority of patients with myelofibrosis. The exception to that are the individuals that really truly have low-risk but have very much of a low symptom burden. All of the aggregate of the experience from both the trials but the real-world evidence, tends to suggest the earlier we use it, the better, because it not only has this impact on spleen and symptoms, but that, I think, is just one superficial lens on the benefit...
I think ruxolitinib in myelofibrosis really should be initiated as early as possible in probably the vast majority of patients with myelofibrosis. The exception to that are the individuals that really truly have low-risk but have very much of a low symptom burden. All of the aggregate of the experience from both the trials but the real-world evidence, tends to suggest the earlier we use it, the better, because it not only has this impact on spleen and symptoms, but that, I think, is just one superficial lens on the benefit. There really is a progression-free survival benefit that’s more difficult to quantify, but is very, very real, and it probably, we obtain the majority of that benefit the earlier we use the therapy. You know, when we look at the data from the COMFORT studies and the earlier Phase I, patients who have very advanced disease, when we start ruxolitinib, they’re going to benefit, but it will be less than the individual that has less massive splenomegaly or less severe cytopenias. So I think earlier is clearly better. You know, the clinical trials started with intermediate two and high-risk patients, But that was very much of an arbitrary decision. That was an extension of the Phase I, the Phase I, first in human, let’s start with the highest risk patients. But there’s really been nothing over time to suggest that there is a need to not utilize that therapy in symptomatic low-risk or intermediate one-risk patients.
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