Ruxolitinib treatment improves muscle mass in patients with myelofibrosis
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LETTER TO THE EDITOR
Ruxolitinib treatment improves muscle mass in patients with myelofibrosis Marko Lucijanic 1 & Davor Galusic 2 & Ena Soric 1 & Martina Sedinic 1 & Marta Cubela 3 & Renata Huzjan Korunic 3,4 & Vlatko Pejsa 1,4 & Rajko Kusec 1,4 Received: 13 August 2020 / Accepted: 26 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, Myelofibrosis is a Philadelphia chromosome-negative chronic myeloproliferative neoplasm characterized by development of bone marrow fibrosis, massive splenomegaly, and life-debilitating constitutional symptoms [1]. JAK inhibitor ruxolitinib has been approved for treatment of intermediate2 and high-risk myelofibrosis and is effective in reduction of splenomegaly and disease-related symptoms [2, 3]. Due to specific reimbursement requirements, to continue ruxolitinib therapy after 6 months, patients taking ruxolitinib in Croatia need to demonstrate either 30% reduction in the absolute spleen diameter (assessed by ultrasound) or 25% reduction in the spleen volume (assessed by computed-tomography (CT) or magnetic-resonance scans). Since 25% reduction in volume corresponds to 9% one-dimensional spleen reduction, patients obtaining CT scans are more likely to fulfill reimbursement requirements, providing a unique source of CTmeasured data. We retrospectively investigated psoas muscle area (PMA) at vertebra L3 level from baseline and 6-month CT scans of myelofibrosis patients from two Croatian hematology centers that were treated with ruxolitinib due to high or intermediate-2 risk disease. Data for a total of 13 patients were available. PMA at 6 months was divided by baseline values to obtain
* Marko Lucijanic [email protected] 1
Hematology Department, University Hospital Dubrava, Av. Gojka Suska 6, 10000 Zagreb, Croatia
2
Hematology Department, University Hospital of Split, Split, Croatia
3
Radiology Department, University Hospital Dubrava, Zagreb, Croatia
4
School of Medicine, University of Zagreb, Zagreb, Croatia
percentage of PMA improvement. Since values were nonnormally distributed, improvement in PMA was tested by paired Wilcoxon signed-rank test, and non-parametric statistical tests (Mann-Whitney U test, Spearman’s rank correlation, χ2 test) were used to compare PMA ratio with clinical characteristics. MedCalc Statistical Software version 19.4.0 (MedCalc Software Ltd., Ostend, Belgium) was used. Median age of analyzed cohort was 70 years, and 6/13 (46%) were males. We observed statistically significant rise in PMA during 6-month ruxolitinib treatment (median PMA 1287 vs 1365 mm²; P = 0.002) with majority of patients experiencing a modest rise in psoas muscle mass and only two patients experiencing a slight decline (among them one confined to the wheelchair due to earlier cervical spine injury) as shown in Fig. 1a. Median PMA improvement after 6 months of ruxolitinib therapy was 6%. A total of 3/11 (23.1%) of patients experienced more than 10% improvement in PMA. PMA improvement of 10% was associated with higher baseline hemoglobin
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