MPN Expert Ruben Mesa on the Anemia-Based Data at ASH
DECEMBER 12, 2017
Ruben Mesa, M.D.
At the 59th American Society of Hematology (ASH) Meeting and Exposition, Rare Disease Report caught up with Ruben Mesa, M.D., Director of the University of Texas Health Cancer Center.
In this video, he discusses the common problem of anemia that can come with myeloproliferative neoplasm (MPN)-associated myelofibrosis, how some of the medications administered can induce it, and the data pertaining to it that was presented at ASH.
Mesa: Anemia with MPN-associated myelofibrosis is a common problem, and really, anemia occurs for a range of reasons in myelofibrosis. The first is the marrow dysfunction; the marrow has the fibrosis and it’s just not producing enough cells. Two, the spleen could be significantly enlarged, and it can be holding onto too many cells, or it can be destroying them prematurely. And three, the medications that we use can induce more anemia. So, ruxolitinib, as a JAK inhibitor, is a very helpful therapy but the creation of red cells is dependent on JAK 2. So when we inhibit JAK 2, it’s a predictable outcome that we develop anemia. So anemia has several contributors, if you would.
Patients with myelofibrosis similarly have baseline anemia, they may have associated with it enzymes, as well as they certainly can have drug-associated anemia when they take a new therapy. So, all of those are contributors when we assess anemia in myelofibrosis. So in terms of anemia here, there’s many different levels of data being presented. Everything from the data from my group looking at the impact of contribution of blood counts on the symptoms and how anemia can worsen those symptoms, new agents that are in development, so terosept was presented the novel therapy for myelofibrosis, showing activity in those groups of patients. On that basis, the very similar agent, luspatercept is going to be tested in a clinical trial. So, a lot of different things that are being evaluated, both in terms of new therapies and a better understanding of the anemia, as well as other agents that continue to be in development, but are not directly necessarily being presented here at ASH, but are looming large. Fedratinib, another JAK 2 inhibitor that recently has come off clinical hold, that may have some benefit in anemia and a 018 that has some activity in anemia. We presented at ASCO early this year momelotinib, that has activity in anemia with myelofibrosis. So, a variety of different things out there, but again remains probably one of the greatest unmet needs.