How do you manage anemia in a patient with myelofibrosis and hemochromatosis?

It is a good question. There isn’t much more you can do. There are new targeted therapies for myelofibrosis which are best answered by an MPD specialist. As for the hemochromatosis, you should still check iron parameters, because if deficiency is present it SHOULD be treated, in this case with IV iron. Frankly, I doubt it will be. This is an extremely difficult problem.

I agree, a very difficult problem. You can still work down the typical pathway for treating anemia in myelofibrosis, by using epo levels to determine if an ESA can be used. If the epo level is high then consider alternatives like luspatercept (based on a phase 2 study in MF) or danazol.

There is data that pacritinib hits ACVR1 leading to anemia responses, so if the patient is also thrombocytopenic and needs spleen and symptomatic treatment, it would be a good consideration. Of course, there is momelotinib, which has an FDA PDUFA date of June 16, and anemia benefit through inhibition of ACVR1 is a key benefit as well.