Post Hoc Analysis Findings Offer Guidance for Anemia Management in Myelofibrosis: Pankit Vachhani, MD

During the final part of his conversation with The American Journal of Managed Care®, Pankit Vachhani, MD, of the University of Alabama at Birmingham, discusses how findings from his post hoc analysis of the phase 3b JUMP trial (NCT01493414), presented earlier this month at the European Hematology Association 2025 Congress, can help guide clinical decision-making for managing anemia in patients with myelofibrosis. He concludes by highlighting key areas for further research in this space.

Watch parts 1 and 2 to learn more about the background, objectives, and key findings of the analysis.

This transcript was lightly edited; captions were auto-generated.

Transcript

How could the results of your post hoc analysis inform real-world clinical decision-making for managing anemia in patients with myelofibrosis?

That's a great question. Today, we have multiple options. As we spoke about, we have 4 JAK [Janus kinase] inhibitors, and at least 1 of these, momelotinib, for example, is approved for patients with myelofibrosis who have anemia. Anemia, though, is not well defined in the label.

We also have ruxolitinib, with its long-term data, including in terms of its overall survival benefits. We know that ruxolitinib is the most commonly used JAK inhibitor, used and studied in, number one, a line-agnostic fashion. More importantly, also, [it was] studied across the range of hemoglobin. It was studied in the COMFORT studies [COMFORT-I (NCT00952289) and COMFORT-II (NCT00934544)], even in patients who were transfusion-dependent.

Now, we have multiple options. I think that the study we spoke about gives us the data from the JUMP analysis. What it tells us is that, yes, anemia is a bad thing to have. We know it from all risk stratification tools, but what the JUMP data analysis tells us is that by doing this rux [ruxolitinib] plus ESA [erythropoietin-stimulating agent] approach, one can achieve and maintain the high doses of rux, which are required for the good clinical outcomes to happen. By doing that, we were able to maintain the hemoglobin levels within 1 g/dL of baseline.

In other words, it gives us the comfort of knowing that we can achieve and get the same clinical benefits, maintain relatively high doses of rux that correlate with good outcomes by using this combination. I guess, for any individual patient, though, my suggestion, as always, will be to personalize the treatment approach. Look at their comorbidities, look at what the insurance approves, look at the logistics of doing this, but know that, in the end, there [are] data now, and we had some data before, as well, but now we have a 101-patient data set that supports this combination as one of the ways that we can counter myelofibrosis and anemia together.

What further research is needed to build upon these findings?

I think we have a lot of questions in the field of myelofibrosis and anemia. We are looking forward to some of the newer treatments, the ones that target both the iron homeostasis through the hepcidin pathways, as well as erythropoiesis, to see if we can improve the anemia outcomes even more than what we have seen with the options that we spoke about.

What we also want to see is that these improvements actually correlate with some additional clinically meaningful outcomes. We know, for example, that patients who have a better anemia profile do better in terms of their survival. What we would love to see is that by improving the anemia situation, meaning by improving their hemoglobin numbers, we actually truly improve their survival, meaning a correlation and causation between an improvement and the overall survival benefits.

We would also, in addition, like to see other drug combinations being tested and used to go beyond what the current drugs and regimens do. I think that will allow us to deliver some of the best outcomes. Eventually, in a world with even more selective JAK inhibitors, perhaps we could avoid some of the anemia-related complications in the first place. So, [there are] a lot of exciting things coming up in this field down the line.