Should JAK Inhibitors Be Considered Prior to Transplant?

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Topics include: Treatments

During a roundtable discussion from the 2014 American Society of Clinical Oncology (ASCO) annual meeting in Chicago, Dr. Srdan Verstovsek, Dr. Ross Levine and Dr. Olatoyosi Odenike discussed how JAK inhibitors may factor in as a treatment for some MPN patients prior to transplant. The experts stressed the importance of continued research in this area, citing examples from recent clinical trials.

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Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Dr. Verstovsek:

And the last question is, is there a role for the JAK inhibitors before the transplant? Is there a value in treating patients that perhaps have advances features and are candidates for the transplant by offering them JAK inhibitors, or this is not necessary? 

Dr. Odenike:    

Yeah, so one issue with transplantation, and we’ve known this for a long time, is that if you have constitutional symptoms, i.e., you’re losing weight, you’re having night sweats, you’re feeling unwell, and if you have massive splenomegaly, these are predictors for not very good outcomes after a transplant.  

So with the advent of JAK inhibitors and knowing that a core benefit of the use of JAK inhibitors like ruxolitinib (Jakafi) is improvement in splenomegaly and constitutional symptoms, it makes absolute sense to sequence these and see, you know, whether it makes an impact on the outcome, you know, prior to and following a transplant.  

This has already been done successfully. There are small, you know, there are reports in small groups of patients of, from European trials that have already been published and there’s an ongoing trial that’s here in the U.S. that’s testing that approach. So, you know, this makes perfect sense.

Dr. Verstovsek:

Makes sense.

Dr. Levine:

But we need to be careful. There were two studies presented at the hematology meeting. One study by Nick Kröger showed exactly what you said—that the patients got to transplant in better condition, and they did quite well. The other study, I believe, actually had significant graft failure, patients actually didn’t take their transplant, the cells didn’t actually make it in.

They had a couple patients that had emergent removal of their spleen, and they had one patient who had a life-threatening blood clot. And there are many differences. The transplant treatment protocols were different. The sickness of the patients were different—the approach to use JAK inhibitors in those trials were different.

So I think to follow what Olatoyosi says, I’m very excited about the idea, but what I tell our patients and our doctors is only do it on a clinical trial.

This is not something that should be done outside of trial, that we don’t want doctors who don’t have access to one of these trials to do it, because we’re learning that one of the specific aspects of transplant in these drugs, how they interact. So I think it’s exciting, and we need to do it. But there’s still a lot to learn about it.

Dr. Verstovsek:

Thank you very much for excellent discussion. Thank you, Ross. Thank you, Olatoyosi. Thank you all for joining us today in Chicago at the ASCO 2014 meeting with the news on new developments in myeloproliferative neoplasms. Thank you and goodbye.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on October 9, 2014