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A real-world cohort study comparing the effects of momelotinib, a Janus kinase inhibitor, on immune cell recovery in ruxolitinib-treated and ruxolitinib-naïve patients with primary and secondary myelofibrosis (n = 46) vs healthy controls (n = 10) was published by Makker et al. in Haematologica.
Key data: T-cell subset frequencies increased by 6 weeks (CD3+: p = 0.01; CD4+: p = 0.03; and CD8+: p = 0.04) and remained elevated through 48 weeks (CD3+: p = 0.03; CD4+: p = 0.03; and CD8+: p = 0.13). Natural killer (NK) cells showed a three-fold increase from baseline to 48 weeks (p < 0.01), while B-cell counts were significantly higher at 6 weeks (p = 0.02) and 48 weeks (p = 0.04).
Key learning: Momelotinib demonstrated early and sustained recovery of T and NK cells, with levels comparable to healthy controls. These effects were observed irrespective of prior ruxolitinib exposure, highlighting momelotinib’s independent immunomodulatory activity.
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A 68-year-old male with primary myelofibrosis received ruxolitinib 10 mg twice daily for 7 months. His spleen size and symptoms are controlled, but Hb remains <8 g/dL. EPO, 210 mU/mL; platelets, 85,000/µL. What is your next step?