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Incidence of blast-phase disease in myelofibrosis, according to anemia severity
Anemia affects almost all patients during the natural progression of myelofibrosis (MF) and is a key factor linked with increased risk of blast-phase (BP) transformation. Around 30–45% of patients who receive ruxolitinib treatment for MF develop Grade 3–4 anemia; however, data surrounding BP progression in patients treated with ruxolitinib are limited.1
Palandri et al.1 published a study in Cancer reporting on the incidence of BP according to anemia severity in a large real-world cohort of patients diagnosed with primary and secondary MF, treated with ruxolitinib. We summarize the key points below.
Study design1
- Retrospective study
- Patients with MF (N = 886) were administered ruxolitinib outside of clinical trials
- Data was collected between 2013 and 2022
Key findings1
- Median ruxolitinib duration was 2.4 years
- Median follow-up duration was 3.1 years
- At ruxolitinib initiation, 67.4% of patients had anemia
- 10.2% were red blood cell (RBC) transfusion-dependent
- 11.1% had an RBC transfusion requirement
- In total, 13.2% of patients experienced BP evolution
- The global BP incidence rate ratio (IRR) was 3.74 per 100 patient-years
- The IRR of BP in patients with no anemia was 2.34 per 100 patient-years vs 4.22 (p = 0.02), 4.89 (p = 0.009), and 4.93 (p = 0.006) per 100 patient-years in patients with Grade 1, Grade 2 and Grade 3–4 anemia, respectively
- The IRR of BP per 100 patient-years was higher in patients who were RBC transfusion-dependent than patients with an RBC transfusion requirement or patients who were RBC transfusion independent (5.03 vs 4.48 vs 3.52 per 100 patient-years, respectively)
- A univariate regression model identified that patients with either a platelet count <100×109/L or anemia had a higher probability of BP evolution (p = 0.006 and p = 0.33, respectively)
- Patients with no anemia had the highest 5-year PFS rate, while patients with Grade 3–4 anemia had the lowest (Figure 1)
Figure 1. 5-year progression-free survival rates according to grade of anemia in patients with MF*
PFS, progression-free survival.
*Adapted from Palandri, et al.1
- During the first 6 months, 9.2% of patients who had no anemia at the start of therapy developed Grade 3–4 anemia during treatment with ruxolitinib
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