How to Improve MPN Treatment Via Symptom Management and Risk Stratification

Recent years have brought exciting advancements in treating myeloproliferative neoplasms (MPNs), and as things continue to change, it is crucial for oncology nurses and other healthcare providers to monitor disease-related symptoms and stratify patients by risk, according to James M. Rossetti, DO.

“Symptom management is key, which is really assessing our patients and better helping them as it relates to their symptoms,” said Rossetti, a hematologist at UPMC Hillman Cancer Center.

Symptom Management in MPNs

Rossetti explained that providers need to do a better job at assessing their patients with MPNs and determining which symptoms are related to the disease.

“Many patients with myeloproliferative disease will tell you that they feel as if they’re ignored for a period of many years with vague symptoms,” he said. “If everything else has been excluded, even in a low-risk patient, I believe that we have to accept and appreciate the fact that the disease can cause significant symptoms by way of cytokine release and others.”

The good news is that newer agents, such as ruxolitinib (Jakafi), are helping improve patients’ symptom burden. Aspirin, which Rossetti described as “one of the age-old drugs” can also help patients manage their symptoms as well. It is important to examine other anti-platelet and new agents that can also benefit these patients as well.

Looking ahead Rossetti mentioned that his team at University of Pittsburgh is opening a clinical trial examining a lysine-specific demethylase inhibitor for patients who failed or are intolerant to JAK inhibition.

“One of the things that we’re excited about with that particular molecule is that, like ruxolitinib and the other agents, it’s oral,” Rossetti said. “The early data looking at symptom management showed spleen size reduction and perhaps even improvement in bone marrow fibrosis. These are early data, to be sure, but they are enough to spur us forward with further investigation.”

Risk Stratification

Risk stratification is another crucial part in managing patients with MPNs.

“Take polycythemia vera (PV); it’s very important that we assess past events with greater care, such as cardiovascular risk factors. It’s easy for us to ask if [patients have] had a pulmonary embolism, but not so much to assess other risk factors that they might have that increase their risk for thrombosis,” Rossetti said.

In determining patients’ risk, Rossetti also includes molecular profiling as well as blood counts and cytogenic modeling.

For myelofibrosis, Rossetti uses the Dynamic International Prognostic Scoring System. He also scores patients frequently and continues to learn more about how to integrate all of that information to a better way for assessing patients.

“It’s very important, because, despite the fact that we do a decent job and we’re doing better and better, we probably still [do not properly risk stratify] a significant number of patients,” he said.

Overall, Rossetti is optimistic that the field will continue to improve.

“We have had a lot of new agents available to us over the past few years. It’s an exciting time in the treatment of MPNs,” he said.

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A version of this article originally appeared on OncLive as, “Symptom Management, Risk Stratification Crucial in MPN Treatment.”