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Azacytidine Added to Ruxolitinib Shows Promise in Myelofibrosis

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Studies are assessing combining the JAK inhibitor ruxolitinib with other agents to improve its efficacy and reinvigorate its effect in patients who progress, relapse, or become intolerant to this treatment. In an open-label, non-randomized, prospective phase II study combining ruxolitinib with the hypomethylating agent azacitidine, treatment response was achieved in 72% of patients (n=33), with a median time to response of 1.8 months.

In the study, azacytidine 25 mg/m2 (days 1-5) was added starting with cycle 4 and could be subsequently increased to 75 mg/m2 (days 1-5). Among the 33 responses, 7 (21%) occurred after azacytidine was added. The study also showed benefits with regard to spleen length reduction, which remained durable in the majority of patients, and in bone marrow reticulin fibrosis grade. The combination was well-tolerated. Only 4 patients (9%) discontinued treatment due to an adverse event, with all secondary to cytopenias.

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Masarova L, Verstovsek S, Hidalgo-Lopez JE, et al. A phase II study of ruxolitinib in combination with azacytidine in patients with myelofibrosis. Blood. 2018 Sep 5. pii: blood-2018-04-846626. doi: 10.1182/blood-2018-04-846626.

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