Ruxolitinib-based combinations in the treatment of myelofibrosis: worth looking forward to
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REVIEW ARTICLE
Ruxolitinib-based combinations in the treatment of myelofibrosis: worth looking forward to Yujin Li 1,2 & Shirong Zhu 1,3 & Weiyi Liu 1 & Jing Ming 1 & Xueying Wang 1,2 & Xiaomei Hu 1 Received: 6 March 2020 / Accepted: 10 April 2020 # The Author(s) 2020
Abstract Ruxolitinib is a targeted drug to treat myelofibrosis (MF). Ruxolitinib has significant advantages in spleen reduction and increasing 5-year overall survival (OS), and ruxolitinib-based combinations might provide more benefits than ruxolitinib monotherapy. In this review, we focus on the data of ruxolitinib-based combinations therapies and treatment-related adverse events (AEs) and safety. We analyzed and summarized the data of ruxolitinib-based combinations. Ruxolitinib combined with prednisone + thalidomide + danazol (TPD), panobinostat, pracinostat, azacytidine, or hydroxyurea has well reduced spleen. Ruxolitinib combined with danazol or TPD had well therapies in improvement of hemoglobin (Hgb) and platelets (PLT). Most ruxolitinibbased combinations therapies showed a superior benefit on reduced treatment-related AEs than ruxolitinib monotherapy. Treatment-related AEs and dose modification affect the safety and tolerability of ruxolitinib-based combinations. Genetic testing before treatment is recommended. To provide better clinical guidance, comparisons of these randomized controlled trials with the trials of ruxolitinib alone are necessary. This review suggests that the clinical application of ruxolitinib-based combinations is worth waiting for. Keywords Myelofibrosis . Ruxolitinib . Hematology . Ruxolitinib-based combinations
Highlights • Ruxolitinib combined with danazol could significantly improve platelet levels and anemia. • Ruxolitinib combined with thalidomide, prednisone, and danazol showed excellent tolerability and safety. • For ruxolitinib combined with lenalidomide, the dose is the key, and ruxolitinib plays a more vital role in the treatment. • Ruxolitinib combined with panobinostat has well tolerance and reduced spleen size. • Ruxolitinib combined with pracinostat showed non-ideal efficacy and tolerance. • Ruxolitinib combined with azacytidine has potential synergy for spleen length reduction and BM fibrosis improvement. • Ruxolitinib combined with hydroxyurea is feasible in real-world practice. * Xiaomei Hu [email protected] Yujin Li [email protected]
Xueying Wang [email protected] 1
Department of Hematology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
2
Graduate School, China Academy of Chinese Medical Sciences, Beijing 100700, China
3
Graduate School, Beijing University of Chinese Medicine, Beijing 100029, China
Shirong Zhu [email protected] Weiyi Liu [email protected] Jing Ming [email protected]
Ann Hematol
Introduction Myelofibrosis (MF) is a breakpoint cluster region protein (BCR)-Abelson tyrosine-protein kinase (ABL)–negative myeloproliferative neoplasm (MPN) and represents a group of tumors caused by abnormal proliferation of one or more myel
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