Institute of Haematology and Transfusion Medicine, KPC Medical College & Hospital, India.
In comparison with conventional chemotherapeutic drugs, the expectations of targeted therapies are high. Imatinib, which targets
Ruxolitinib reduces constitutional symptoms and reduces spleen size in PMF . However, the observations of reduction in constitutional symptoms and the decrease in spleen size after treatment with a JAK1/2 inhibitor in patients with wild-type
Severe splenomegaly has been associated with poor outcomes after hematopoietic stem cell transplant (HSCT). Given this, the study author predicts that ruxolitinib administered prior to HSCT may improve the outcomes of HSCT in PMF. However, as mentioned in the penultimate section of the article, it is difficult to understand how this drug would have any impact on the outcome of HSCT by decreasing the proinflammatory cytokine levels when the mechanism of action for this effect is still unknown.
The outcomes of trials of ruxolitinib in PMF have raised many questions and provided a few answers. What is the specificity of ruxolitinib as a targeted drug? Are there any other undiscovered pathways in the pathogenesis of PMF that hinder the action of ruxolitinib? These are some of the many questions that further studies need to answer. In my opinion, then and only then will the question "Will JAK1/2 inhibitors change the standard of care for myelofibrosis?" be answered appropriately.