Supportive Care

Supportive care is given to improve the quality of life for patients with MF. The goal of supportive care is to prevent or treat the symptoms of MF.

Anemia

Anemia is observed in more than 50 percent of patients with MF at the time of diagnosis. Before considering treatment options, it is important for doctors to rule out and treat the most common causes of anemia such as bleeding, iron deficiency, vitamin B12 deficiency and folic acid deficiency.

Treatment

Blood transfusions are recommended for patients whose anemia is causing symptoms. Blood transfusions can increase a patient’s red blood cell count and ease symptoms such as fatigue and weakness.

Additional treatment options are based on the patient’s serum erythropoietin (EPO) levels.

  • For patients with serum EPO levels lower than 500 mU/mL, treatment may include:
    • Erythropoietin stimulating agents (darbepoetin alfa or epoetin alfa). Erythropoietin is a substance naturally produced by the kidneys that stimulates the bone marrow to produce red blood cells. Erythropoietin stimulating agents (ESAs) are made in the laboratory and they also work by stimulating the bone marrow to make red blood cells.
  • For patients with serum EPO levels at or higher than 500 mU/mL, treatment may include:
    • Danazol or alternative androgens, synthetic versions of male hormones (androgens) that may help build up red blood cell production
    • The immunomodulators (IMiDs) thalidomide (Thalomid®) and lenalidomide (Revlimid®), both given by mouth, which may help improve red blood cell counts. These drugs may be combined with prednisone, a steroid. 

Enlarged Spleen (Splenomegaly) 

Many patients with MF have enlarged spleens that may cause symptoms such as abdominal discomfort, pain under the left ribs and a feeling of fullness without eating or after eating a small amount.

Treatment

There are several options for dealing with the painful effects of an enlarged spleen, which include:

  • Ruxolitinib (Jakafi®), which has been shown to reduce spleen size in some patients
  • Hydroxyurea (Hydrea®), which may reduce the size of an enlarged spleen and relieve related symptoms
  • Interferon alfa (Intron A, Roferon-A, Pegasys), which can control spleen enlargement
  • Surgical removal of the spleen (splenectomy), which may be considered if other forms of therapy have not reduced the pain or complications associated with an enlarged spleen. Benefits and risks of this procedure need to be weighed:
    • Benefits include a reduction of symptoms, decreased portal hypertension and less need for red blood cell transfusions.
    • Possible risks include hemorrhaging, blood clots, infection, liver enlargement and an increased platelet count.
  • Radiation therapy, which uses high powered x-rays to shrink the spleen. When other treatment methods have failed and surgical removal of the spleen is not a viable option, radiation therapy can be used to help reduce the size of the spleen.
  • Embolization of the spleen. This minimally invasive treatment is an alternative to the surgical removal of all or part of the spleen. While the patient is sedated, the doctor injects embolizing agents through a catheter into an artery to block blood flow to the spleen in order to reduce its size.

For information about the drugs listed on this page, visit Drug Listings.

Thrombocytosis and Leukocytosis 

MF patients suffer from thrombocytosis (bone marrow produces too many platelets) or leukocytosis (bone marrow produces too many white blood cells).

Treatment

The chemotherapy drug hydroxyurea may be given to reduce the high platelet and white blood cell counts. It may also help treat other MF symptoms, including an enlarged spleen, night sweats and weight loss. Patients with low blood cell counts or severe anemia should not take hydroxyurea.

 

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