How the Emerging MPN Pipeline Will Reshape PV Nursing and Patient Care

In the rapidly evolving landscape of myeloproliferative neoplasms (MPNs), groundbreaking pipeline therapies are poised to redefine the standard of care for patients living with polycythemia vera (PV).

Following a recent Oncology Nursing News case-based roundtable discussion, Dana Delaski, MSN, FNP-BC, a hematology nurse practitioner at the University of Mississippi Medical Center, shared clinical insights on how pipeline agents will reshape patient lives and oncology nursing workflows.

Key Emerging Pipeline Agents

The discussion highlighted several promising therapies currently advancing through clinical development:

• Extended-Release Ruxolitinib (Jakafi): A once-daily formulation that transitions patients from a twice-daily dosing schedule, significantly lowering daily pill burden.
• Rusfertide (Mimrylo): A self-injected subcutaneous therapy designed to mimic hepcidin, with the potential to reduce or entirely eliminate the need for therapeutic phlebotomy.
• Givinostat: An investigational oral histone deacetylase (HDAC) inhibitor being evaluated for high-risk, JAK-positive PV patients.

Mitigating the Pill and Travel Burden

For many patients with PV, managing their disease requires an exhausting, long-term combination of frequent clinic visits, medication compliance, and invasive clinical procedures. Reducing these demands is a primary goal.

"The less pills patients have to take, the better," Delaski remarked, emphasizing that transitioning to once-daily dosing is a significant victory for long-term patient compliance.

Furthermore, home-based administration represents a shift for individuals who live far from specialized medical centers. "A lot of our patients travel hours, or an hour or more, to get to clinic," Delaski explained. Transitioning to at-home subcutaneous therapies minimizes travel demands, preserving patient autonomy, reducing transportation barriers, and ultimately enhancing overall quality of life.

Eliminating Phlebotomy and Easing Nurse Workflows

While therapeutic phlebotomy remains a foundational strategy to maintain hematocrit levels below 45% to prevent life-threatening cardiovascular and thrombotic events, it presents distinct clinical challenges. Many patients are highly intolerant of phlebotomy, suffer from needle anxiety, experience progressive iron deficiency, or struggle with venous access over years of treatment.

By minimizing or removing the phlebotomy requirement, rusfertide will relieve the physical and mental burden on patients while freeing up valuable clinic chair time in outpatient infusion centers.

For oncology nurses, these innovations will fundamentally shift day-to-day clinical workflows. Historically, nurses have seen PV patients frequently during routine blood draws and phlebotomy appointments. Delaski pointed out that because "patients tell nurses things that they don't always tell providers," these frequent procedural encounters have served as critical windows for nurses to catch and report uncontrolled subjective symptoms like aquagenic pruritus, fatigue, and headaches.

As treatment shifts to home-based, self-administered regimens, nursing workflows will transition from reactive, procedural care to proactive, virtual symptom management and remote patient education. Rather than managing phlebotomy side effects, nurses will lead telehealth assessments and utilize validated symptom tracking tools to ensure optimal, continuous disease control. Ultimately, this pipeline promises to transform PV from an invasive, clinic-bound procedure-based disease to a highly controlled, home-managed chronic condition.