Managing the Side Effects of MPNs

What are MPNs?

Myeloproliferative neoplasm (MPN) treatments have drastically evolved since the beginning of the 2000s. MPNs are described by the MPN Research Foundation as “a type of blood cancer found in the bone marrow which typically overproduces one of the mature blood elements” (i.e. red and white blood cells and platelets used for clotting).¹

The three main types of MPNs are:

• myelofibrosis

• essential thrombocythemia

• polycythemia vera

In a recent Patient Power webinar, members of the leukemia team from the University of Texas MD Anderson Cancer Center discussed issues affecting people who have been diagnosed with an MPN.

The panel included Dr. Naveen Pemmaraju, Associate Professor in the Department of Leukemia at the Division of Cancer Medicine, and two physician assistants, Julie Huynh-Lu and Rodney Haltom.

Managing MPN Fatigue

The number one side effect described by MPN patients is fatigue. As the panel explained, many patients experience a decrease in the amount of energy they have. For some, this means not being able to do what they were able to do before their MPN diagnosis.

However, the disease and its impact on someone’s life can differ greatly between patients. As Dr. Pemmaraju explains, fatigue is one of the most commonly missed MPN symptoms. This is important because fatigue has two very important components in an MPN diagnosis:

1. Fatigue is common in every type of MPN and can even occur in the early stages of the disease before it is diagnosed. Feeling empowered to discuss symptoms can help patients get specialized treatment and care.

2. It is also important for people living with an MPN to actively listen to their body so that their health care team can properly assist in terms of drug treatment, talking about diet, or other factors impacting one’s cancer journey.

One way of fighting the slowing effect of fatigue is exercise. Even though someone with an MPN might not be able to go as far or do as much as they could before developing the disease, being active helps release endorphins and trains the body to build up strength. While this might sound counterintuitive, research shows that exercise leads to physical, mental and emotional benefits for the majority of cancer patients. Before starting any exercise program, talk to your doctor.

For additional tips, read: ‘I’m Exhausted’: 10 Tips for Coping With MPN Fatigue.

Blood Tests and MPNs

Another topic that was covered in regard to fatigue was the fact that many MPN patients report feeling fatigued even when their blood count levels are okay. As Dr. Pemmaraju highlights, the most important thing for a patient to do is to listen to their own body. Some doctors celebrate what he calls ‘victories on paper’ even when patients continue to report issues related to their disease. Dr. Pemmaraju explained again how MPNs are unique to each individual and should be treated as such.

Itching Caused by MPNs

In How to Manage Itchy Skin Caused by MPNs, we explain, “Pruritus is the medical term for skin itching [and]… is a common symptom of all three types of MPNs.” Pruritus comes from a natural cell byproduct produced for such things as allergic reactions from a bee sting. Unfortunately, because cancerous cells grow at an exponential rate, these byproducts are released in response to normal everyday activities causing the skin to itch. For many patients living with an MPN, even a hot shower or bath can cause a severe and long-lasting itch.

As the panel from MD Anderson explained, over-the-counter treatments may provide relief to people experiencing pruritus. Antihistamines such as Benadryl and Zyrtec can be used to help control itching. As always, please speak to your cancer team before starting any new medications or complementary therapies.

MPNs and Bone Pain

Another MPN side effect is bone pain. This is often caused by an overload of histamines in the blood but can also be a side effect of MPN treatments.

The team at MD Anderson treats bone pain with antihistamines, similar to how they treat itching. Having access to an over-the-counter drug — under the care of a doctor — allows patients easier and more affordable ways of control the disease and its side effects.

MPNs and Weight Gain

Weight gain is a side effect that can be caused directly by MPN treatments, specifically ruxolitinib (Jakafi). In the process of treating an MPN, ruxolitinib may change the way a patient’s body processes fats, causing some people to gain weight.

Weight gain varies from patient to patient; diet and exercise also play a role. Staying active and maintaining a healthy diet while taking ruxolitinib may help limit weight gain.

MPNs and Gastrointestinal (GI) Issues

Another drug used to treat MPNs has a different impact on the body. Dr. Pemmaraju explained that fedratinib (Inrebic) sometimes causes “GI toxicity; things like vomiting, nausea and diarrhea.” This means that instead of gaining weight some MPN patients may even lose weight, which could lead to malnourishment.

Again, a balanced diet that is agreed upon with your care team is key to ensuring the best possible outcome in your cancer journey. You can also improve your overall health by getting a sufficient amount of sleep and adequate rest.

Final Thoughts on MPN Side Effects

Keep in mind that the two drugs mentioned work to inhibit a specific type of cell production. A recent Patient Power MPN Answers Now series describes how JAK 1 and 2 inhibitor treatments like these are “a strategy to, with medication, turn off… signaling and tone down [this production] a bit. This has been an effective strategy for many patients in controlling high blood counts, in controlling symptoms that might be associated with their MPN, and also in controlling spleen size, which affects many MPN patients.”

These drugs work to prevent the production of certain elements in blood production, where many MPN side effects develop.

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To participate in a clinical trial for MPNs, use our online search tool or visit the MPN Research Foundation to find open trials.