VIDEO: Expert discusses treatment options for myelofibrosis

In terms of treatment options that are currently or commercially available for patients with Myelofibrosis, it really is a JAK inhibitor-based therapeutic decision-making algorithm. Most patients will get Ruxolitinib upfront to address spleen and symptom burden. However, you have low platelets, Pacritinib remains a viable option as a frontline therapy. If you have very significant anemia transfusion dependence, in fact, Momelotinib could be an option upfront.

And then really in the second line, you have the pick of the litter. I think sometimes Fedratinib is forgotten. That's a very active, very valuable asset, particularly for spleen. Spleen, worst thing on Ruxolitinib, I like to turn to Fedratinib is one of the more potent spleen reducing drugs. But again, if you're faced in the second line with either loss of response or inadequate response with Ruxolitinib or response and maybe some degree of anemia, thrombocytopenia that's complicating the dosing of Ruxolitinib, you do have options like Pacritinib and Momelotinib and even Fedratinib.

And I will point out that although it would be off-label, one can always consider using a drug like Luspatercept, an erythropoiesis maturation agent, as an add-on strategy to Ruxolitinib if you have spleen and symptom well-controlled but anemia is still an issue. And again, that's off-label. We're waiting for the independent study to read out, but there's a lot of enthusiasm that will also add an opportunity to capitalize and maximize our Ruxolitinib response experience.