Tips on using ruxolitinib in everyday practice as therapy for myelofibrosis

Baseline factors associated with response to ruxolitinib: an independent study on 408 patients with myelofibrosis

“…The second result of this analysis is that RUX starting and titrated dose may influence spleen, but not symptoms, response. A trend for higher response rates in patients receiving titrated doses ≥10 mg BID was first highlighted in the ruxolitinib Phase 1-2 trial, and current expert recommendation suggest to maintain the maximum tolerated dose [ 19 – 22 ]. Additionally, ruxolitinib dose intensity, expressed as median cumulative dose, was found to be independently associated with spleen responses, together with higher JAK2 V617F allele burden, in a recent study on 69 patients [ 13 ].…”

Recommendations on the use of ruxolitinib for the treatment of myelofibrosis

“…According to our experience and in line with clinical trials, patients without JAK2 mutation may also respond to ruxolitinib [3,16,17,28]. The overall mutation profile characterization is important for the diagnosis of MF patients, but also has a significant impact on prognosis and likelihood of treatment success, which appears to diminish with the presence of multiple mutations [29].…”

“…Regardless of Hb levels, starting doses of ruxolitinib should be 15 mg twice daily for MF patients with baseline platelet counts between 100-200 × 10 9 /L and 20 mg twice daily for patients with platelet counts >200 × 10 9 /L ( Table 1) [28]. For patients with low-baseline platelet counts (50-100 × 10 9 /L), studies suggested that 5 mg starting doses with gradual increase up to 10 mg twice daily may be the best approach [34].…”

“…Dose tapering when stopping ruxolitinib treatment has been suggested [28], as sudden discontinuation may induce symptoms reactivation within one week [17] and serious AEs [37]. Our recommendation is to stop the treatment by reducing the dose by 5 mg twice daily every week.…”