Understanding The Nuance and Individualization of Myelofibrosis Treatment

Treating patients with myelofibrosis is a highly nuanced and important topic that requires a great deal of understanding to navigate, according to Prithviraj Bose, MD.

During the Society of Hematological Oncology 2025 Annual Meeting, CancerNetwork® spoke with Bose, a professor in the Department of Leukemia in the Division of Cancer Medicine at the University of Texas MD Anderson Cancer Center, following a presentation he delivered titled “Individualizing Treatment Selection for [myelofibrosis]”.

Currently, there are 4 JAKinhibitors approved in the landscape, including ruxolitinib (Jakafi), momelotinib (Ojjaara), pacritinib (Vonjo), and fedratinib (Inrebic). According to Bose, all of them have uses in different patient groups and scenarios, which are always dependent upon the clinical needs of the patient. Factors such as splenomegaly, symptoms, and anemia are all key considerations.

Bose added that with myelofibrosis, a physician is not just treating a certain stage of the disease but managing a different, individualized manifestation of the disease with each patient.

Transcript:

Individualizing treatment in [myelofibrosis] is a very important topic, and I’m thankful to the selection committee for giving me that topic because it’s become highly nuanced in today’s day and age. One, we have 4 JAK inhibitors approved—they are all JAK inhibitors, but they are all a little bit different. They each have their place. That, itself, was a big chunk of my talk: where you may want to pick each of the different agents. Then, there are also other aspects beyond JAK inhibitors; interferons may have a role in early disease. Anemia-directed therapies, which do not have to be JAK inhibitors, have a place in patients who present with anemia without much splenomegaly or symptoms. It is quite a nuanced topic because unlike other cancers, [myelofibrosis] is not something we treat with a one-size-fits-all [approach] in the first line, second line, or third line. It just does not work like that.

It depends on the clinical needs of the patient, which could be splenomegaly, symptoms, anemia, or something else. In combination, patients will often have more than 1 problem. It becomes highly nuanced, like I said before, to evaluate all of the data in their totality and choose the right drug for each patient, given that you’re not just treating a certain stage of disease; you’re treating different manifestations of the disease in each patient. It’s very individualized, and it should be.

Reference

Bose P. Individualizing treatment selection for MF. Presented at the Society of Hematological Oncology 2025 Annual Meeting; September 3-6, 2025; Houston, TX.