The Nature of the Beast
he challenges of treating myelofibrosis are even more challenging within the setting of the community physician, who may only see 1 to 4 MF patients a year. For many, diagnosis and treatment are a matter of managing patient expectations with a straightforward singular approach: delaying the inevitable.
“MF is a challenging condition to manage, and there are few, if any, textbook cases,” Dr. Senecal explains. “But, together, we can always find a way to move forward in a meaningful way. You want patients to know there is always hope, but ensure they’re not chasing dreams.”
Dr. Senecal’s panoramic experience as a physician at the Fred Hutchison Cancer Research Center and now at a large hospital system in Tacoma, has kept him from becoming an isolated community physician. “You don’t want your MF patients to miss opportunities of new research or important clinical trials, “ Dr. Senecal points out. “A patient can be a perfect candidate, but if you don’t know what’s available, or you don’t reach out to an MF specialist who knows what’s going on, they could be too late or miss it altogether.”
A better second chance
ost opportunity is somewhat a thing of the past when collaborating within the context of a co-treatment team. “I can’t spend the time necessary to pour through all of the latest myelofibrosis literature like an MF specialist, so it makes sense to reach out,” Dr. Senecal says. “Especially when the answer from an expert in the field is a phone call away.” And what’s more, this relationship opens up the potential for both physician and patient to learn so much more about the disease and how best to manage it.
"It’s an amazing benefit to both you and your patients. There’s nothing quite like collaborating with another physician."
“There’s just so much you don’t know you don’t know, “ Dr. Senecal explains. Patients begin to understand the nuances of their disease, and physicians can make better informed decisions. “It’s an amazing benefit to both you and your patients. Collaboration is simply a better way to practice medicine in these rare diseases.”
The scientific insider
xperts like Dr. Scott pull from their own research on MF and dive deep into the latest data to guide hematologists-oncologists and their patients through management options.
They take into account a myriad of factors that impact patient care—biologic differences, rate of disease progression, presence or absence of cytopenias, transfusion dependence, symptom burden, antecedent disease, and prognostic risk. Even more prominent these days are the emerging data on the type and number of mutations detected, allele burden, and the various pathophysiologic pathways that drive disease.
“I think we are transitioning away from a sole morphologic interpretation of the disease, into more of a complex look at the underlying genetic underpinnings of the disease,” says Dr. Scott. “It is precisely because of the enormous complexity of MF, and its rarity, that collaboration between MPN specialists and community physicians is so critical.”
“Some cases are more ideal for consultation and co-treatment scenario than others.”
“Those of us who are closely interrogating the literature and conducting the research will be better able to help guide care. We can help differentiate between the two types of MF and offer the most current interventions to physicians and patients.”
Dr. Scott categorizes the two types of MF by cellular production profile. One type is more proliferative in nature, with high blood counts, more pronounced splenomegaly, and a single JAK2 mutation. These patients tend to require cytoreductive management.
But there are even more patients who present with myelodepletive symptoms: marrow failure, multiple mutations, and cytopenias that require blood transfusions. These patients, says Dr. Scott, don’t need cytoreductive management as much as they need hematopoietic improvement.
“Problem is, right now, we don’t have a lot of ways to improve hematopoiesis that are effective for these patients. That’s why these patients are so much more difficult to manage.”
The next breakthrough for those cytopenic MF patients will come from collaborations like Dr. Scott’s and Dr. Senecal’s; experts working with community physicians and their patients to surround the disease, revealing even greater insights and investigating potential pathways and future treatments.
“Don’t be afraid to reach out,” Dr. Senecal counsels. “The treatment of myelofibrosis is advancing. It’s not standing still. And what you don’t know might be a missed opportunity for one of your patients.”