Pat Langley Computer Science and Engineering Arizona State University Tempe, Arizona USA
Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic...
-
Upload
gavin-chase -
Category
Documents
-
view
218 -
download
0
Transcript of Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic...
![Page 1: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/1.jpg)
Ruben A. Mesa, MDProfessor of Medicine
Chair, Division of Hematology & Medical Oncology
Mayo ClinicArizona, USA
Overcoming your MPN!
Arizona, USA
![Page 2: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/2.jpg)
Symptomatic Burden in MPNs
• Why do symptoms matter in MPNs
• Development and testing of MPN Symptom Assessment
• Current and Future Management of MPN Symptoms
• Application in Clinical Trials and Next Steps
![Page 3: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/3.jpg)
Symptoms in 1179 MPD PatientsSymptoms in 1179 MPD Patients
Mesa et. al. Cancer 2007;109:68-76
![Page 4: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/4.jpg)
Burden of ET/PV
MicrovascularSymptoms
MicrovascularSymptoms
MacrovascularRisk
MPN AssociatedSymptoms
![Page 5: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/5.jpg)
ClonalMPN cells
EnlargedSpleen
AnemiaSymptoms•Fever•Weight Loss•Night Sweats•Itching•Bone pain•Fatigue
FibrosisIn
Marrow
![Page 6: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/6.jpg)
Burden of Myelofibrosis
Anemia/Cytopenias
Anemia/Cytopenias
Splenomegaly MF AssociatedSymptoms
![Page 7: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/7.jpg)
Femme Ivre Se Fatigue1902
O. Huber Collection
Pablo Picasso (1881-1973)
![Page 8: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/8.jpg)
Symptomatic Burden in MPNs
• Why do symptoms matter in MPNs
• Development and testing of MPN Symptom Assessment
• Current and Future Management of MPN Symptoms
• Application in Clinical Trials and Next Steps
![Page 9: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/9.jpg)
Current Medications for MF
Medicines forMF Anemia
•Androgens•EPO•Thalidomide
Medicines forAnemia &Spleen
•Lenalidomide
Medicines forMF Spleen
•Hydroxyurea•Busulfan•2-CDA
•Splenectomy•Splenic Radiation
Medicines forMF Symptoms
•None
![Page 10: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/10.jpg)
Net Symptom Burden
NETEffect
DiseaseSx
DiseaseSx
RxTox
Time on a Medical Therapy
![Page 11: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/11.jpg)
Relieve Burden of MPN Suffering
Prolong Life
Cure
Measured in the Eyes of the patient
Compared to ?
Delay Progression Compared to Controls?
AbsenceOf Dz
ENDPOINTS
VALIDATION
![Page 12: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/12.jpg)
MPN-SAF (N=1433)Myeloproliferative Neoplasm Symptom Assessment Form
English12%
Spanish14%
Italian13%
German4%
Swedish8%
French33%
Dutch16%
Scherber et. al. 2011
![Page 13: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/13.jpg)
All for measurement of theValidated Brief Fatigue Inventory
Scherber et. al. 2011
![Page 14: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/14.jpg)
Vascular
Psychiatric
Spleen/ Proliferation Related
Cytokine Related
QOL
Scherber et. al. 2011
![Page 15: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/15.jpg)
MPN-SAF 10 Item Total Symptom Score (TSS)
Symptom 1 to 10 (0 if absent) ranking*1 is most favorable and 10 least favorable
Please rate your fatigue (weariness, tiredness) by circling the one number that best describes your WORST level of fatigue during past 24 hours
(No Fatigue) 0 1 2 3 4 5 6 7 8 9 10 (Worst Imaginable)
Circle the one number that describes how, during the past week how much difficulty you have had with each of the following symptoms
Filling up quickly when you eat (Early satiety) (Absent) 0 1 2 3 4 5 6 7 8 9 10 (Worst Imaginable)
Abdominal discomfort (Absent) 0 1 2 3 4 5 6 7 8 9 10 (Worst Imaginable)
Inactivity (Absent) 0 1 2 3 4 5 6 7 8 9 10 (Worst Imaginable)
Problems with concentration - Compared to prior to my MPD
(Absent) 0 1 2 3 4 5 6 7 8 9 10 (Worst Imaginable)
Night sweats (Absent) 0 1 2 3 4 5 6 7 8 9 10 (Worst Imaginable)
Itching (pruritus) (Absent) 0 1 2 3 4 5 6 7 8 9 10 (Worst Imaginable)
Bone pain (diffuse not joint pain or arthritis) (Absent) 0 1 2 3 4 5 6 7 8 9 10 (Worst Imaginable)
Fever (>100 F) (Absent) 0 1 2 3 4 5 6 7 8 9 10 (Daily)
Unintentional weight loss last 6 months (Absent) 0 1 2 3 4 5 6 7 8 9 10 (Worst Imaginable)
Scherber et. al. 2011
![Page 16: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/16.jpg)
MPN-SAF (N=1433)Myeloproliferative Neoplasm Symptom Assessment Form
P<0.001
Mea
n T
SS
(0-
10 P
oin
t S
cale
)
Scherber et. al. 2011
![Page 17: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/17.jpg)
TSS MF Subtypes (N=284)Myeloproliferative Neoplasm Symptom Assessment Form
P = N.S.Between MF Subtypes
Mea
n T
SS
(0-
10 P
oin
t S
cale
)
Scherber et. al. 2011
![Page 18: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/18.jpg)
Prevalence of “Constitutional” Symptomsin 1433 MPN Patients
Scherber et. al. 2011* - P<0.001
*
***
![Page 19: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/19.jpg)
Severity of “Constitutional” Symptomsin 1433 MPN Patients
Scherber et. al. 2011
* - P<0.001
*
**
*
![Page 20: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/20.jpg)
Spleen Derived Symptoms in 1433 MPN Patients
Scherber et. al. 2011
Prevalence Severity
* - P<0.001
***
*
*
![Page 21: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/21.jpg)
Prevalence of “End Organ” Symptomsin 1433 MPN Patients
Scherber et. al. 2011* - P<0.001
**** *
![Page 22: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/22.jpg)
Severity of “End Organ” Symptomsin 1433 MPN Patients
Scherber et. al. 2011
* - P<0.001 ** **
![Page 23: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/23.jpg)
Decreased QOL in 1433 MPN Patients
Scherber et. al. 2011
P<0.001P<0.001
![Page 24: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/24.jpg)
EORTC QLQ-C30 Scores (Mean + SD)
Current Data Samuelsson 2006 Ŧ EORTC 2008* EORTC 2008* EORTC 2008*
ET (N=161)Baseline values for PV and ET pts (N=1616)
General Population (N=7,802)
Cancer patients with recurrent or metastatic disease (N=4,812)
Patients with AML (N=155)
EORTC Subscales
Physical Functioning 85.1 ± 16.9 90.6 ± 11.5 89.8 ± 16.2 75.8 ± 23.1 N/A
Role Functioning 85.0 ± 23.0 81.5 ± 24.5 84.7 ± 25.4 60.7 ± 35.1 N/A
Emotional Functioning 77.7 ± 22.9 82.4 ± 17.1 76.3 ± 22.8 68.7 ± 24.8 82.2 ± 18.9
Cognitive functioning 83.4 ± 19.4 86.7 ± 17.4 86.1 ± 20.0 80.5 ± 23.2 86.1 ± 18.5
Social Functioning 88.4 ± 19.7 89.6 ± 18.6 87.5 ± 22.9 70.5 ± 30.7 66.1 ± 31.0
Global Health Status/QOL 71.1 ± 24.9 72.1 ± 23.4 71.2 ± 22.4 56.3 ± 25.6 N/A
EORTC Symptom Scales
Fatigue 26.9 ± 25.5 23.1 ± 24.1 24.1 ± 24.0 41.8 ± 29.4 36.2 ± 22.7
Nausea/ Vomiting 4.0 ± 9.7 2.6 ± 6.2 3.7 ± 11.7 13.1 ± 22.5 9.0 ± 18.3
Pain 14.3 ± 23.1 15.4 ± 25.2 20.9 ± 27.6 33.7 ± 32.4 13.7 ± 20.4
Dyspnea 18.5 ± 25.8 10.6 ± 15.7 11.8 ± 22.8 23.4 ± 30.1 11.3 ± 17.1
Insomnia 25.0 ± 27.4 19.3 ± 27.5 21.8 ± 29.7 33.6 ± 33.4 20.4 ± 26.1
Appetite loss 5.1 ± 14.7 2.6 ± 9.1 6.7 ± 18.3 28.2 ± 34.9 18.0 ± 30.5
Constipation 19.0 ± 29.0 4.4 ± 13.8 6.7 ± 18.4 23.2 ± 32.3 7.9 ± 19.1
Diarrhea 9.0 ± 18.3 4.4 ± 11.4 7.0 ± 18.0 10.7 ± 22.4 12.6 ± 25.1
Financial Difficulties 8.0 ± 19.3 7.2 ± 17.8 9.5 ± 23.3 16.2 ± 27.7 18.7 ± 28.8
EORTC ET Scales Comparison
Ŧ Samuelsson et. al. (2006). "A Phase II Trial of Pegylated Interferon a-2b Therapy for Polycythemia Vera and Essential Thrombocythemia." Cancer. 106(11):2397-2405.*Scott et. al. (2008). "EORTC QLQ-C30 Reference Values." Publication from the EORTC Quality of Life Group. Found online at
http://groups.eortc.be/qol/downloads/reference_values_manual2008.pdf.
![Page 25: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/25.jpg)
EORTC PV Scales Comparison
Ŧ Samuelsson et. al. (2006). "A Phase II Trial of Pegylated Interferon a-2b Therapy for Polycythemia Vera and Essential Thrombocythemia." Cancer. 106(11):2397-2405.*Scott et. al. (2008). "EORTC QLQ-C30 Reference Values." Publication from the EORTC Quality of Life Group. Found online at
http://groups.eortc.be/qol/downloads/reference_values_manual2008.pdf.
EORTC QLQ-C30 Scores (Mean + SD)
Current Data Samuelsson 2006 Ŧ EORTC 2008* EORTC 2008* EORTC 2008*
PV (N=145)Baseline values for PV and ET pts (N=1616)
General Population (N=7,802)
Cancer patients with recurrent or metastatic disease (N=4,812)
Patients with AML (N=155)
EORTC Subscales
Physical Functioning 83.3 ± 17.7 90.6 ± 11.5 89.8 ± 16.2 75.8 ± 23.1 N/A
Role Functioning 85.2 ± 22.7 81.5 ± 24.5 84.7 ± 25.4 60.7 ± 35.1 N/A
Emotional Functioning 78.2 ± 20.8 82.4 ± 17.1 76.3 ± 22.8 68.7 ± 24.8 82.2 ± 18.9
Cognitive functioning 83.0 ± 18.8 86.7 ± 17.4 86.1 ± 20.0 80.5 ± 23.2 86.1 ± 18.5
Social Functioning 88.3 ± 20.1 89.6 ± 18.6 87.5 ± 22.9 70.5 ± 30.7 66.1 ± 31.0
Global Health Status/QOL 65.7 ± 24.8 72.1 ± 23.4 71.2 ± 22.4 56.3 ± 25.6 N/A
EORTC Symptom Scales
Fatigue 29.3 ± 21.9 23.1 ± 24.1 24.1 ± 24.0 41.8 ± 29.4 36.2 ± 22.7
Nausea/ Vomiting 3.3 ± 8.2 2.6 ± 6.2 3.7 ± 11.7 13.1 ± 22.5 9.0 ± 18.3
Pain 14.6 ± 20.4 15.4 ± 25.2 20.9 ± 27.6 33.7 ± 32.4 13.7 ± 20.4
Dyspnea 19.6 ± 24.2 10.6 ± 15.7 11.8 ± 22.8 23.4 ± 30.1 11.3 ± 17.1
Insomnia 26.6 ± 28.0 19.3 ± 27.5 21.8 ± 29.7 33.6 ± 33.4 20.4 ± 26.1
Appetite loss 10.3 ± 21.7 2.6 ± 9.1 6.7 ± 18.3 28.2 ± 34.9 18.0 ± 30.5
Constipation 13.4 ± 24.5 4.4 ± 13.8 6.7 ± 18.4 23.2 ± 32.3 7.9 ± 19.1
Diarrhea 6.3 ± 16.3 4.4 ± 11.4 7.0 ± 18.0 10.7 ± 22.4 12.6 ± 25.1
Financial Difficulties 6.4 ± 15.9 7.2 ± 17.8 9.5 ± 23.3 16.2 ± 27.7 18.7 ± 28.8
![Page 26: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/26.jpg)
EORTC MF Scales Comparison
Ŧ Samuelsson et. al. (2006). "A Phase II Trial of Pegylated Interferon a-2b Therapy for Polycythemia Vera and Essential Thrombocythemia." Cancer. 106(11):2397-2405.*Scott et. al. (2008). "EORTC QLQ-C30 Reference Values." Publication from the EORTC Quality of Life Group. Found online at
http://groups.eortc.be/qol/downloads/reference_values_manual2008.pdf.
EORTC QLQ-C30 Scores (Mean + SD)
Current Data Samuelsson 2006 Ŧ EORTC 2008* EORTC 2008* EORTC 2008*
MF (N=96)Baseline values for PV and ET pts (N=1616)
General Population (N=7,802)
Cancer patients with recurrent or metastatic disease (N=4,812)
Patients with AML (N=155)
EORTC Subscales
Physical Functioning 74.9 ± 20.7 90.6 ± 11.5 89.8 ± 16.2 75.8 ± 23.1 N/A
Role Functioning 68.8 ± 28.9 81.5 ± 24.5 84.7 ± 25.4 60.7 ± 35.1 N/A
Emotional Functioning 76.5 ± 20.5 82.4 ± 17.1 76.3 ± 22.8 68.7 ± 24.8 82.2 ± 18.9
Cognitive functioning 77.0 ± 20.4 86.7 ± 17.4 86.1 ± 20.0 80.5 ± 23.2 86.1 ± 18.5
Social Functioning 74.9 ± 24.1 89.6 ± 18.6 87.5 ± 22.9 70.5 ± 30.7 66.1 ± 31.0
Global Health Status/QOL 59.9 ± 24.6 72.1 ± 23.4 71.2 ± 22.4 56.3 ± 25.6 N/A
EORTC Symptom Scales
Fatigue 41.0 ± 25.1 23.1 ± 24.1 24.1 ± 24.0 41.8 ± 29.4 36.2 ± 22.7
Nausea/ Vomiting 6.3 ± 11.4 2.6 ± 6.2 3.7 ± 11.7 13.1 ± 22.5 9.0 ± 18.3
Pain 22.6 ± 27.8 15.4 ± 25.2 20.9 ± 27.6 33.7 ± 32.4 13.7 ± 20.4
Dyspnea 29.8 ± 29.0 10.6 ± 15.7 11.8 ± 22.8 23.4 ± 30.1 11.3 ± 17.1
Insomnia 33.7 ± 30.6 19.3 ± 27.5 21.8 ± 29.7 33.6 ± 33.4 20.4 ± 26.1
Appetite loss 15.1 ± 23.1 2.6 ± 9.1 6.7 ± 18.3 28.2 ± 34.9 18.0 ± 30.5
Constipation 16.8 ± 26.1 4.4 ± 13.8 6.7 ± 18.4 23.2 ± 32.3 7.9 ± 19.1
Diarrhea 21.1 ± 27.1 4.4 ± 11.4 7.0 ± 18.0 10.7 ± 22.4 12.6 ± 25.1
Financial Difficulties 17.5 ± 28.7 7.2 ± 17.8 9.5 ± 23.3 16.2 ± 27.7 18.7 ± 28.8
FOR INTERNAL USE ONLY. NOT FOR DETAILING. DO NOT COPY OR DISTRIBUTE.
![Page 27: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/27.jpg)
Martyrdom of Saint Sebastian1473
National Gallery, London
Antonio del Pollaiuolo (1431-1498)
![Page 28: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/28.jpg)
Symptomatic Burden in MPNs
• Why do symptoms matter in MPNs
• Development and testing of MPN Symptom Assessment
• Current and Future Management of MPN Symptoms
• Application in Clinical Trials and Next Steps
![Page 29: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/29.jpg)
Managing MPN Fatigue
• Exercise
• Healthy Lifestyle and Diet
• Correction of Iron Deficiency When Possible
• Stimulants– Ritalin/Provigil/ Nuvigil
• JAK2 Inhibitors
![Page 30: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/30.jpg)
Managing MPN Micro-vascular Sx
• Aspirin
• Smoking Cessation
• Management of Blood Counts
• ? Additional Anti-platelet therapy
![Page 31: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/31.jpg)
Managing MPN Itching (Pruritus)
• Anti-histamines
• Therapeutic UV Light
• Physical Measures (avoiding hot baths, air drying)
• Interferon / Peg Interferon
• JAK2 Inhibitors
![Page 32: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/32.jpg)
Managing MPN Cachexia & Splenomegaly
• JAK 2 inhibitors (Both)
• Hydroxycarbamide (Spleen alone)
• Splenectomy (Spleen Alone)
• Splenic Radiation (Spleen Alone)
• Other Chemotherapy (Spleen Alone)
![Page 33: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/33.jpg)
JAK2 Inhibitors in Development for MF
Clinical Phase of Testing
![Page 34: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/34.jpg)
0
1
2
3
4
5
Early Satiety Ability toWalk Around
AbdominalDiscomfort
0 15 28 84 168 252 0 15 28 84 168 252 0 15 28 84 168 252
Days on Study
Sy
mp
tom
Sc
ore
(M
FS
AF
0-1
0 P
oin
t S
ca
le)
Ruxolitinib Therapy Associated with Rapid and Durable Improvement
In Symptoms Associated with Enlarged Spleen
Mesa et. al. Cancer 2011
![Page 35: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/35.jpg)
0
1
2
3
4
5
6
Night Sweats FatigueItching
0 15 28 84 168 252 0 15 28 84 168 252 0 15 28 84 168 252
Days on Study
Sy
mp
tom
Sc
ore
(M
FS
AF
0-1
0 P
oin
t S
ca
le)
Ruxolitinib Therapy Associated with Rapid and Durable Reduction of Symptoms Associated with Elevated
Inflammatory Cytokines
Mesa et. al. Cancer 2011
![Page 36: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/36.jpg)
Ruxolitinib Phase II
Mesa et. al. Cancer 2011
![Page 37: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/37.jpg)
S. Verstovsek, H. Kantarjian, R. Mesa, et. al. NEJM 2010;363:1117-27
![Page 38: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/38.jpg)
ETPV
Thrombosis& Bleeding
Short Term
Post ET/PV MF& MPN Blast Phase
Long Term
All Risk = ASA
High and ? Int Risk = Cytoreduction
No Known Therapy? JAK2 Inhibitors
![Page 39: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/39.jpg)
Management of PV
• ALL PV Patients– Maintain HCT <45% Men, 42% Women– Low Dose ASA– Aggressive control of CV risk factors
• Cytoreduction– High Risk or– Intol to Phlebotomy, Increasing Spleen, Severe Sx
Plt >1500 x 10(9)/L, or prog WBC
– Medications• Hydroxyurea or Interferon alpha as Front line (or second)• Busulfan, pipobroman, P-32 as second line
Barbui et. al. LeukemiNET Consensus Guidelines JCO 2011 in press
![Page 40: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/40.jpg)
Management of ET
• ALL ET Patients– Low Dose ASA– Aggressive control of CV risk factors
• Cytoreduction– High Risk
– Medications• Hydroxyurea as Front line• Anagrelide second line• Interferon alpha third line• Busulfan, pipobroman, P-32 for elderly
Barbui et. al. LeukemiNET Consensus Guidelines JCO 2011 in press
![Page 41: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/41.jpg)
![Page 42: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/42.jpg)
Morphologic change after IFN therapy in a patient with primary myelofibrosis (After Median 3 years of Rx).
Silver R T et al. Blood 2011;117:6669-6672
Silver et. al. Blood 2011•17 “Early” PMF (MF<Grade 3)•IWG (11 low, 6 Int 1)•INF2b or PEG Inf-2a•IWG-MRT
2 CR, 7 PR, 1 CI (59% Response)
Gowin et. al. ASH 2011•17 “Early” PMF (MF<Grade 3)•PEG Inf-2a•IWG-MRT
1 CR, 2 PR, 1 CI (29% Response)
![Page 43: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/43.jpg)
![Page 44: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/44.jpg)
Verstovsek et. al. ASH 2010; Abstract 313
![Page 45: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/45.jpg)
Verstovsek et. al. ASH 2010; Abstract 313
![Page 46: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/46.jpg)
Verstovsek et. al. ASH 2010; Abstract 313
![Page 47: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/47.jpg)
Verstovsek et. al. ASH 2010; Abstract 313
![Page 48: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/48.jpg)
Verstovsek et. al. ASH 2010; Abstract 313
![Page 49: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/49.jpg)
The Broken Column1944
Museo Dolores Olmedo, Mexico
Frida Kahlo (1907-1954)
![Page 50: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/50.jpg)
Symptomatic Burden in MPNs
• Why do symptoms matter in MPNs
• Development and testing of MPN Symptom Assessment
• Current and Future Management of MPN Symptoms
• Application in Clinical Trials and Next Steps
![Page 51: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/51.jpg)
COMFORT-I: Study Design
• Spleen volume by MRI every 12 weeks
• Daily assessment of symptoms from Day -7 through week 24
• Cross over to ruxolitinib was possible
1:1
Ruxolitinib15 or 20 mg BID
Placebo
Randomize
• PMF or PPV-MF, or PET-MF
• INT-2 or high risk
• Palpable spleen ≥5 cm
• Platelet count ≥100 x109/L
• JAK2 V617F positive or negative
BID, twice daily; COMFORT: COntrolled MyeloFibrosis study with ORal JAK inhibitor Treatment; CT, computed tomography; ECOG PS, Eastern Cooperative Oncology Group Performance Status; INT-2, intermediate-2; MRI, magnetic resonance imaging; PET-MF, post-essential thrombocythemia-myelofibrosis; PMF, primary myelofibrosis; PPV-MF, post-polycythemia vera-myelofibrosis.
![Page 52: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/52.jpg)
Symptom Response COMFORT-1
Mesa et. al. EHA 2011
Ruxolitinib
Placebo
![Page 53: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/53.jpg)
![Page 54: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/54.jpg)
PGIC Scores of Improvement at Week 24
Mesa et. al. EHA 2011
![Page 55: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/55.jpg)
Relationship between Spleen volume Reduction and Symptom/QoL Outcomes
All PBO <10% 10 - <35% 35%-70
-50
-30
-10
10
30
50
Reduction in Spleen Volume
N=99
N=20p=0.0004
N=46p<0.0001
N=60p<0.0001
% C
han
ge
in T
ota
l S
ymp
tom
Sco
reM
ean
S
EM
All PBO <10% 10 - <35% 35%-70
-50
-30
-10
10
30
50
70
Reduction in Spleen Volume
N=96
N=20p=0.0304
N=44p=0.001
N=59p<0.0001
% C
han
ge
in T
ota
l A
bd
om
inal
Sym
pto
m S
core
(M
ean
S
EM
)
All PBO <10% 10 - <35% 35%-12.5
-7.5
-2.5
2.5
7.5
12.5
17.5
22.5
Reduction in Spleen Volume
N=98N=22
p=0.4176
N=46p<0.0001
N=64p<0.0001
Ch
ang
e in
Glo
bal
Hea
lth
Sta
tus/
Qo
L S
core
(M
ean
S
EM
)
All PBO <10% 10 - <35% 35%-12.5
-7.5
-2.5
2.5
7.5
12.5
17.5
22.5
Reduction in Spleen Volume
N=105
N=23p=0.9206
N=50p<0.0001
N=65p<0.0001
Ch
ang
e in
PR
OM
IS F
atig
ue
Sco
re (
Mea
n
SE
M)
All PBO <10% 10 - <35% 35%
0
1
2
3
4
5
Reduction in Spleen Volume
N=101
N=23p=0.0058
N=50p<0.0001 N=62
p<0.0001
Pat
ien
t G
lob
al I
mp
ress
ion
of
Ch
ang
e S
core
(M
ean
S
EM
)
![Page 56: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/56.jpg)
Change in EORTC QLQ-C30 Scores From Baseline to Week 48
• Patients in the ruxolitinib arm had more improvement in symptoms compared with patients in the BAT arm
• Improvements were seen by week 8 and continued through week 48 Scores selected represent symptoms relevant to MF patients.
Wo
rsen
ing
Imp
rove
me
nt
Pain
Appetite loss
Dyspnea
Fatigue Insomnia
Mea
n ch
ange
from
bas
elin
e
Ruxolitinib
BAT
Harrison et. al. EHA 2011 (a1020) Oral Sunday
Harrison et. al. ASCO 2011 a6501
![Page 57: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/57.jpg)
Symptomatic Change in Control Arms of the COMFORT TrialsEORTC-QLQ-C30
“Meaningful” Change ≥ 10 Point ChangeValues only shown for those with data at both baseline and after 24 weeks
![Page 58: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/58.jpg)
Symptom Responses to TG101348(SAR302503)
Pardanani et. al. JCO 2011;29(7):789-796
Early SatietyFatigue
Night Sweats
![Page 59: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/59.jpg)
> 9 Months Sustained Improvement in MF-related Symptoms Observed Using MF-SAF
3*
Mesa et. al. EHA 2011 (a1022) Oral Sunday
![Page 60: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/60.jpg)
Pardanani ASH 2010; Abstract 460
CYT387 Phase I/II in MF
![Page 61: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/61.jpg)
Comparing JAK2 InhibitorsEfficacy
SpleenSpleen MFSymptoms
MFSymptoms AnemiaAnemia
Phase I Testing
![Page 62: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/62.jpg)
First Line Therapy of Myelofibrosis in 2012
Primary, Post ET or Post PV Myelofibrosis
Calculate DIPSS MF Score &Assess MF Symptoms (MPN-SAF)
Low RiskMed S = 185mAsymptomatic
Low RiskMed S <185mSymptomatic
Int-1Med S = 78m
Int-2 & High RiskMed S = 16-35m
MPN-BPMed S <3m
? Allo SCTEligible
ObservationVs. Interferon
JAK2 Inhib(If Many Sx)
JAK2 InhibVs. Allo SCT
Vs. Anemia Rx
Allo SCTJAK2 Inhib
Vs. Anemia Rx
Induction
HypomethVs. TrialVs. Supp
YES Response
YES
NONO
N.B.Consider Rx for Prevention of
Vascular Events in Appropriate Patients (Aspirin & Cytoreduction)
JAK2 Inhibitor•Ruxolitinib (Jakifi)•Clinical Trial JAK2 Inhib
Anemia Rx•IMID•Androgens
![Page 63: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/63.jpg)
123456789
10111213141516171819202122232425262728293031323334353637383940414243444546474849505152535455
C D E FCountry First Name Last Name InstitutionArgentina Federico Sackman, MD FUNDALEU, Fundación Argentina Contra la LeucemiaAustralia Cecily Forsyth Gosford Hospital, NSW, AustraliaAustralia Constantine Tam, MD St Vincent’s Hospital Melbourne, AustraliaCanada Lynda Foltz, MD Providence Hematology, BC CanadaCanada Vikas Gupta, MD Princess Margaret Hospital, Toronto, CanadaFrance Jean Loup Demory Service d'Ematologie Clinique Group d'Etudes et Richerche des Myelofibrosis France Brigitte Dupriez, MD Centre Hospitalier de LENSFrance Jean-Jacques Kiladjian Hopital Saint-Louis, Paris, FranceGermany Heike Pahl, PhD University Hospital Freiburg, GermanyIreland Mary Francis McMullen, MD Belfast City HospitalIsrael Michal Haran, MD Kaplan Medical Center, Rehovot, IsraelItaly Tiziano Barbui, MD Ospedali Riuniti di BergamoItaly Giovanni Barosi, MD Laboratory of Clinical Epidemiology. IRCCS Italy Francesco Passamonti, MD University of Pavia Italy Alessandro Vannucchi, MD University of FlorenceMexico David Gomez-Almaguer Department of Hematology, Hospital Universitario UANL, Monterrey, MexicoNetherlands Suzan Commandeur LUMC, Leiden, NetherlandsNetherlands Harry Schouten, MD, PhD University Hospital Maastricht, NetherlandsNetherlands Peter te Boekhorst Erasmus, MC, Rotterdam, NetherlandsNetherlands Sonja Zweegman, MD VU Univserity Medical Center, Amsterdam, NetherlandsNew Zealand Hilary Blacklock, MD Mercy Specialist Centre, Auckland, New ZealandPanama Francis Guerra Hospital Regional Rafael HernandezSingapore Wee Joo Chng, MB ChB Dept. of Haematology, National University Hospital, SingaporeSpain Carlos Besses, MD Hospital del Mar, Barcelona, SpainSpain Fancisco Cervantes, MD Hematology Department, Hospital Clínic, Barcelona, Spain,Spain Dolores Fernandez-Casados University Hospital La Paz, Madrid, SpainSpain Ana Kerguelen Fuentes Univsersity Hospital La Paz, Madrid, SpainSweden Johanna Abelsson Sahlgrenska Univeristetssjukhuset and Uddevalla hospital, SwedenSweden Bjorn Andreasson, MD Sahlgrenska Univeristetssjukhuset and Uddevalla hospital, SwedenSweden Peter Johansson, MD Sahlgrenska University Hospital, SwedenSweden Jan Samuelsson, MD Verksamhetsområde Internmedicin, Södersjukhuset, StockholmTaiwan Ken-Hong Lim Mackay Memorial Hospital, Taipei, TaiwanUK Anthony Green, MD Cambridge University, Cambride, UKUK Claire Harrison Guys and St. Thomas's, London, UKUK Deepti Radia Guys and St. Thomas's, London, UKUruguay Pablo Muxi, MD Hospital Britanico, Montevideo, UruguayUSA Jessica Altman, MD Northwestern University, Chicago, IL, USAUSA Murat Arcasoy, MD Duke University Medical Center, Durham, NCUSA Amylou Dueck, PhD Mayo Clinic ArizonaUSA Jason Gotlib, MD Stanford Cancer Center, Stanford, CaliforniaUSA Elizabth Hexner University of Pennsylvania, Pennsylvania, USAUSA Catriona Jamieson, MD UCSD, San Diego, CA, USAUSA Ross Levine, MD Memorial Sloan Kettering, New York, NYUSA Ruben Mesa, MD Mayo Clinic ArizonaUSA Alison Moliterno, MD John Hopkins, Baltimore, MDUSA Casey O'Connell USC, Los Angeles, CaliforniaUSA Olatoyosi Odenike, MD University of Chicago, ILUSA Joseph Prchal, MD University of Utah, Salt Lake City, UT, USAUSA Robyn Scherber Rosalind Franklin University of Medicine, ChicagoUSA Robert Silver, MD NY Presbyterian Hospital-Weill Cornell Medical Center, NY, New YorkUSA Jeff Sloan, PhD Mayo Clinic RochesterUSA Brady Stein, MD Northwestern University, Chicago, IL, USAUSA Martin Tallman, MD Memorial Sloan Kettering, New York, NYUSA Srdan Verstovsek, MD MD Anderson Cancer Center, Houston, TX, USA
54 MPN Investigators19 Countries
•North America•EU•Australasia•South America•Asia
![Page 64: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/64.jpg)
MPN-SAFDiary for 7 days
Physician Visit
PhysicianAssessmentreturn
Begin new non experimental intervention for MPN
On Therapy >30 but <180 days
MPN-SAFDiary for 7 days
Enroll
Physician Visit
PhysicianAssessmentDay 1
Patient
Physician
MPN-QOL ISG Trial 1Serial MPN Symptom Assessment on Standard Rx
![Page 65: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/65.jpg)
MPN-SAFDiary/FACT BMT
Physician VisitDay 0,30,100,180,365
PhysicianAssessmentreturn
ASCT vs. Standard RXClinical Choice
MPN-SAFDiary/FACT BMT
Enroll
Physician Visit
PhysicianAssessmentDay 1
MF PatientHLA Typed
Physician
MPN-QOL ISG Trial 2Serial MF Symptom Assessment in Patients Undergoing ASCT
![Page 66: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/66.jpg)
To Heal
• To restore to health or soundness
“www.thefreedictionary.com”
![Page 67: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/67.jpg)
Medicine Wheel of Health“Integrative Medicine”
![Page 68: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/68.jpg)
The Race (with No Finish Line)
Illness Wellness
Medicines
Surgery
Transplant
Exercise
Spirituality
Family Nutrition
![Page 69: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/69.jpg)
Patient Focused Strategy
MPNPatient
IntegrativeCare
FosteringPatientCommunities
Team BasedCareState of the Art Care
CareTeams
Clinical TrialAs appropriate
UpfrontEducation
![Page 70: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/70.jpg)
Exercise and MPNs
• Optimize– Flexibility– Heart/ lung function– Muscle tone– Improve strength– Improve sleep– Improve fatigue
![Page 71: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/71.jpg)
Range of Needs
• Early stage:– Define limitations (or perceived limitations)
– Needs may mirror those of all adults
• Moderate stages:– Overcoming barriers related to disease
– Overcoming medication side effects
• Advanced stage:– Maximize mobility
– Maximize flexibility
![Page 72: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/72.jpg)
Evans et. al. Oncology 2002;16 (9 Suppl 10):109-115
![Page 73: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/73.jpg)
Evans et. al. Oncology 2002;16 (9 Suppl 10):109-115
![Page 74: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/74.jpg)
Vicious Cycle
FatigueFatigue
DeconditioningDeconditioning
Loss ofLoss ofMuscleMuscle BeingBeing
SedentarySedentary
![Page 75: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/75.jpg)
The goal
![Page 76: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/76.jpg)
“In 5 years we will have regrets and remorse for the things we did not do, rather than what we did.”
![Page 77: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/77.jpg)
![Page 78: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/78.jpg)
![Page 79: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/79.jpg)
What have I learned?• Don’t wait to go to Alaska
![Page 80: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/80.jpg)
Quotes from Erma BombeckWritten as she was dying from Cancer
• If I had my life to live over I would…
• Have gone to bed when I was sick instead of pretending the earth would go into a holding pattern if I weren’t there for a day
![Page 81: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/81.jpg)
I would have...
• Burned the pink candle sculpted like a rose before it melted in storage
![Page 82: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/82.jpg)
I would have...
• Sat on the lawn with my grass stains
![Page 83: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/83.jpg)
I would have...
• Talked less and listened more
![Page 84: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/84.jpg)
I would have...
• Invited friends over to dinner even if the carpet was stained or the sofa faded
![Page 85: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/85.jpg)
I would have...
• Shared more of the responsibility carried by my husband
![Page 86: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/86.jpg)
I would have...
• Never have insisted the car windows be rolled up on a summer day because my hair had just been teased and sprayed
![Page 87: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/87.jpg)
I would have...
• Don’t worry about who doesn’t like you, who has more or who is doing what. Instead, cherish the relationships we have with those who do love us.
![Page 88: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/88.jpg)
I would have...
• Never have bought anything just because it was practical, wouldn’t show soil, or was guaranteed to last a lifetime
![Page 89: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/89.jpg)
I would have...
• Instead of wishing away nine months of pregnancy, I’d have cherished every moment and realized that the wonderment growing inside me was the only chance in life to assist God in a miracle
![Page 90: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/90.jpg)
I would have...
• Taken the time to listen to my grandfather ramble about his youth
![Page 91: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/91.jpg)
I would have...
• Cried and laughed less while watching TV and more while watching life
![Page 92: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/92.jpg)
I would have...
• But mostly, given another shot at life, I would seize every minute… look at it and really see it… live it and never give it back. Stop sweating the small stuff.
![Page 93: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/93.jpg)
Carpe Diem
Seize the day!
![Page 94: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/94.jpg)
![Page 95: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/95.jpg)
Acknowledgements
• Mayo Clinic– Amylou Dueck, PhD
– Jeff Sloan, PhD
– Tim Beebe, PhD
– John Camoriano, MD
– Ayalew Tefferi, MD
• USA– Robyn Scherber MPH
– Ron Hoffman, MD
– S. Verstovsek, MD
– Gail Roboz, MD
• UK– Deepti Radia, MD
– Claire Harrison, MD
– Mary Francis McMullin, MD
• France– Jean-Jacques Kiladjian
• Italy– Tiziano Barbui, MD
– Alessandro Vannucchi, MD
– Francesco Passamonti, MD
– Giovanni Barosi, MD
– Alessandro Rambaldi, MD
– Maria Ferarri, MD
• Sweden– Peter Johansson, MD, PhD
– Bjorn Andreasson, MD
– Jan Samuelsson, MD
– Gunnar Birgegard, MD
• Denmark– Hans Hasselbalch, MD
• Germany– Heike Pahl, PhD– Martin Grisshammer, MD
CMPD EDUCATION
FOUNDATION
![Page 96: Ruben A. Mesa, MD Professor of Medicine Chair, Division of Hematology & Medical Oncology Mayo Clinic Arizona, USA Overcoming your MPN! Arizona, USA.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649da75503460f94a92d1c/html5/thumbnails/96.jpg)
The Painters Honeymoon1864
Museum of Fine Arts, Boston
Lord Frederic Leighton(1830-1896)