title: Management of myelofibrosis: JAK inhibition and beyond.
abstract: Myelofibrosis (MF) is characterized by bone marrow fibrosis with subsequent extramedullary hematopoiesis and abnormal cytokine expression leading to splenomegaly, constitutional symptoms and cytopenias. The discovery of the JAK2 V617F mutation in the majority of MF patients has been followed by significant progress in drug development for MF. Areas covered: In this article, we review advances in the understanding of the underlying disease biology, prognostic assessment and therapeutic modalities for MF. We provide clinical trial evidence behind using the JAK2 inhibitor ruxolitinib, erythropoiesis stimulating agents, androgens, immunomodulatory drugs, interferon, cytoreductive drugs and hypomethylating agents in MF. Finally, we review novel therapeutic options for MF including the new JAK1/2 inhibitors, ruxolitinib based combination approaches as well as novel therapeutic agents. Expert commentary: Despite significant reduction of splenomegaly and improvement of symptom burden and a signal for survival improvement, ruxolitinib does not lead to major reductions in JAK2 V617F allele burden and bone marrow fibrosis. No ruxolitinib-based combination approach has so far demonstrated superiority over ruxolitinib monotherapy. The novel JAK2 inhibitors pacritinib and momelotinib, other JAK inhibitors, telomerase inhibitors, anti-fibrosis agents and hsp90 inhibitors are in different stages of development.
authors.affiliation: a Yale University School of Medicine , Department of Internal Medicine, Section of Hematology and the Yale Cancer Center , New Haven , CT , USA.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Stahl
authors.affiliation: a Yale University School of Medicine , Department of Internal Medicine, Section of Hematology and the Yale Cancer Center , New Haven , CT , USA.
authors.forename: Amer M
authors.initials: AM
authors.lastname: Zeidan
mesh_terms: D019943:Amino Acid Substitution; D000728:Androgens / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000379:methods; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007372:Interferons / Q000627:therapeutic use*; D053614:Janus Kinase 2 / Q000037:antagonists & inhibitors* / Q000235:genetics / Q000378:metabolism; D020125:Mutation, Missense; D009570:Nitriles; D055728:Primary Myelofibrosis / Q000188:drug therapy* / Q000201:enzymology / Q000235:genetics; D011720:Pyrazoles / Q000627:therapeutic use*; D011743:Pyrimidines
chemical_list: D000728:Androgens; D006397:Hematinics; D007155:Immunologic Factors; D009570:Nitriles; D011720:Pyrazoles; D011743:Pyrimidines; C540383:ruxolitinib; D007372:Interferons; C507924:JAK2 protein, human; D053614:Janus Kinase 2
keywords: JAK inhibitor; Myelofibrosis; momelotinib and imetelstat; pacritinib; ruxolitinib