Theme 2 consensus recommendations
| Defining when to initiate or modify treatment for thrombocytopenia . | Strength of recommendation,∗ median score (mean score) . | Level of consensus† . |
|---|---|---|
| Q4. How should JAKi treatment be adjusted in patients with thrombocytopenia? Consensus statement Fedratinib, momelotinib, pacritinib, or low-dose ruxolitinib are all clinically viable options for treating patients with MF and thrombocytopenia with a platelet count of 50 × 109/L to 100 × 109/L. For patients with a platelet count of <50×109/L <50 × 109/L, momelotinib or pacritinib (where available) are the preferred JAKi options with data supporting their use. Where momelotinib or pacritinib are unavailable, alternative JAKi dosing should be clinically guided, on a case-by-case basis, and based on the spleen size, symptoms, JAKi tolerance, blood counts, and bleeding manifestations. For example, in patients without clinically relevant bleeding, ruxolitinib dose reduction may stabilize platelet count while controlling the spleen size and symptoms. | 9 (8.80) | n/N = 25/25 (100%) |
| Q5. How does drug availability affect thrombocytopenia treatment in the LATAM region? Consensus statement Thrombocytopenia treatment for patients with MF in the LATAM region is a challenge. Where access to options such as momelotinib and pacritinib (JAKi therapies with data supporting their safety in patients with severe thrombocytopenia) is restricted, patients receiving other JAKi therapies may benefit from JAKi dose reduction to reduce treatment-related thrombocytopenia. While agents that are effective in increasing platelet count are lacking, low-dose corticosteroids (alone or combined with thalidomide) may help to improve platelet count. | 9 (8.24) | n/N = 23/25 (92%) |
| Defining when to initiate or modify treatment for thrombocytopenia . | Strength of recommendation,∗ median score (mean score) . | Level of consensus† . |
|---|---|---|
| Q4. How should JAKi treatment be adjusted in patients with thrombocytopenia? Consensus statement Fedratinib, momelotinib, pacritinib, or low-dose ruxolitinib are all clinically viable options for treating patients with MF and thrombocytopenia with a platelet count of 50 × 109/L to 100 × 109/L. For patients with a platelet count of <50×109/L <50 × 109/L, momelotinib or pacritinib (where available) are the preferred JAKi options with data supporting their use. Where momelotinib or pacritinib are unavailable, alternative JAKi dosing should be clinically guided, on a case-by-case basis, and based on the spleen size, symptoms, JAKi tolerance, blood counts, and bleeding manifestations. For example, in patients without clinically relevant bleeding, ruxolitinib dose reduction may stabilize platelet count while controlling the spleen size and symptoms. | 9 (8.80) | n/N = 25/25 (100%) |
| Q5. How does drug availability affect thrombocytopenia treatment in the LATAM region? Consensus statement Thrombocytopenia treatment for patients with MF in the LATAM region is a challenge. Where access to options such as momelotinib and pacritinib (JAKi therapies with data supporting their safety in patients with severe thrombocytopenia) is restricted, patients receiving other JAKi therapies may benefit from JAKi dose reduction to reduce treatment-related thrombocytopenia. While agents that are effective in increasing platelet count are lacking, low-dose corticosteroids (alone or combined with thalidomide) may help to improve platelet count. | 9 (8.24) | n/N = 23/25 (92%) |