How do you approach management of symptomatic myelofibrosis in transplant-ineligible patients with severe thrombocytopenia, e.g., platelets in the 20s, who have an inadequate response to pacritinib?

This is a very difficult clinical scenario and, unfortunately, a common one in advanced myelofibrosis!

Regarding the thrombocytopenia, we typically use a transfusion threshold of 10K in the absence of bleeding. The data for TPO agonist use in myelofibrosis are quite sparse, so I typically don't utili...

I would approach this clinical situation using the available clinical tools. First, I need to define the type of myelofibrosis present, primary or secondary, since the former is more aggressive than the latter. This determination would be based on genomics and cytogenetics, not phenotype. We can exp...