MF Hypothetical Patient Case
Presentation
Anthony, a 74-year-old patient, was diagnosed with post-polycythemia vera (post-PV) myelofibrosis (MF) 2 years ago. Until recently, treatment with a Janus kinase inhibitor (JAKi) was sufficient to manage his symptoms. However, Anthony now presents to his hematologist-oncologist with new bone pain and fatigue that has been worsening over the past month.Passamonti F, et al. Crit Rev Oncol Hematol. 2022;180:103862. Passamonti F, Mora B. Blood. 2023;141(16):1954-1970. Myeloproliferative neoplasms (MPNs). Blood Cancer United. Accessed April 2, 2026. https://bloodcancerunited.org/blood-cancer/myeloproliferative-neoplasms-mpns
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Patient name: Anthony |
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Age: 74 years |
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Background: Retired teacher, living with his wife |
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Medical history: Diagnosed with post-PV MF 2 years ago and has been receiving treatment with a stable dose of a JAKi, but recently developed bone pain and severe fatigue |
In the last 2 years since receiving my diagnosis, I have been on a JAKi medication to manage my symptoms.
I was feeling fine for a while. After we retired, my wife and I started working on our garden together as a hobby, and I had been feeling well enough to join her again.
However, about a month ago, I started feeling too exhausted to do my usual activities despite my ongoing treatment. I also started having hip and lower-back pain that I had not experienced before.
I am going back to my hematologist-oncologist to check on my symptoms and see if we need to change anything about my treatment.
Workup
Prior to his appointment, Anthony’s hematologist-oncologist reviewed records from his initial diagnosis and follow-up exams over the past 2 years.
At the visit, substantial splenomegaly was noted, with the spleen tip palpable 7 cm below the left costal margin—approximately 5 cm larger than at prior exams.Tremblay D, et al. Ann Hematol. 2020;99(7):1441-1451.
Assessment of Symptom Burden
Based on Anthony’s responses to the Myeloproliferative Neoplasm Symptom Assessment Form Total Symptom Score (MPN-SAF TSS) conducted at the appointment, his symptoms had worsened compared to his established baseline.Emanuel RM, et al. J Clin Oncol. 2012;30(33):4098-4103. Bose P. Curr Hematol Malig Rep. 2024;19(3):111-119.
In response, the hematologist-oncologist ordered peripheral blood testing, including a complete blood count (CBC) with differential and a comprehensive metabolic panel (CMP).
CBC ResultsLab and imaging tests. Blood Cancer United. Accessed June 5, 2026. https://bloodcancerunited.org/blood-cancer-care/adults/lab-imaging-tests Laboratory Test Reference Ranges. American Board of Internal Medicine. Updated January 2026. Accessed June 5, 2026. https://www.abim.org/media/e2wdwdqu/laboratory-reference-ranges.pdf Neutrophilia. Cleveland Clinic. Updated February 7, 2022. Accessed June 4, 2026. https://my.clevelandclinic.org/health/diseases/22367-neutrophilia Lymphocytes. Cleveland Clinic. Updated June 20, 2022. Accessed June 5, 2026. https://my.clevelandclinic.org/health/body/23342-lymphocytes Monocytes. Cleveland Clinic. Updated January 3, 2025. Accessed June 5, 2026. https://my.clevelandclinic.org/health/body/22110-monocytes Eosinophils. Cleveland Clinic. Updated July 5, 2022. Accessed June 5, 2026. https://my.clevelandclinic.org/health/body/23402-eosinophils Basophils. Cleveland Clinic. Updated November 4, 2024. Accessed June 5, 2026. https://my.clevelandclinic.org/health/body/23256-basophils
NOTES: CMP results were normal and included no indication of liver dysfunction. Additional tests were ordered to rule out other underlying causes of anemia or splenomegaly. No relevant nutritional deficiencies (eg, iron, vitamin B12, vitamin B6, or folate), infections, or signs of gastrointestinal bleeding were identified.Comprehensive Metabolic Panel. Cleveland Clinic. Updated July 3, 2024. Accessed June 4, 2026. https://my.clevelandclinic.org/health/diagnostics/22058-comprehensive-metabolic-panel-cmp Verstovsek S. Ann Hematol. 2023;102(4):689-698. Aldulaimi S, Mendez AM. Am Fam Physician. 2021;104(3):271-276.
Considering that Anthony had developed new or worsening symptoms and anemia despite ongoing treatment with a JAKi, the hematologist-oncologist decided to complete a more extensive evaluation. During this time period, Anthony received supportive care with 2 blood transfusions to manage his anemia symptoms.
Diagnostic Summary
The hematologist-oncologist ordered a peripheral blood smear, serum lactate dehydrogenase (LDH), and serum erythropoietin (sEPO) tests. Samples from Anthony’s bone marrow were also collected and submitted for updated histopathologic, cytogenetic, and molecular testing.
Summary of Updated Diagnostic WorkupMyeloproliferative neoplasms (MPNs). Blood Cancer United. Accessed April 2, 2026. https://bloodcancerunited.org/blood-cancer/myeloproliferative-neoplasms-mpns Laboratory Test Reference Ranges. American Board of Internal Medicine. Updated January 2026. Accessed June 5, 2026. https://www.abim.org/media/e2wdwdqu/laboratory-reference-ranges.pdf Swerdlow SH, Campo E, Harris NL, et al, eds. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Revised 4th ed. Lyon: International Agency for Research on Cancer (IARC); 2017. Ng ZY, et al. Int J Lab Hematol. 2023;45(suppl 2):59-70.
Based on the updated workup and the International Consensus Classification (ICC) diagnostic criteria for secondary MF, post-PV MF remained the most appropriate diagnosis in Anthony’s case.Arber DA, et al. Blood. 2022;140(11):1200-1228. Tefferi A, Barbui T. Am J Hematol. 2023;98(9):1465-1487.
Treatment Planning
Based on the Myelofibrosis Secondary to PV and ET Prognostic Model (MYSEC-PM) and information from the updated workup, the hematologist-oncologist noted that Anthony has intermediate-2 post-PV MF.
MYSEC-PM Risk EvaluationMYSEC Prognostic Model Risk Calculator. Accessed June 5, 2026. http://www.mysec-pm.eu/ Passamonti F, et al. Leukemia. 2017;31(12):2726-2731.
After I initially diagnosed Anthony with post-PV MF, he began to receive treatment with a JAKi. We were able to find a stable dose that was managing symptoms of the disease for a while.
However, given the recent changes in his status, I think it is time for us to revisit his treatment plan. We will discuss all of his options, including continued supportive care and additional active treatments that may help manage his severe anemia and worsening symptoms.
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