Maria Arini Lopez, PT, DPT, CSCS, CMTPT, CIMT is a freelance medical writer and Doctor of Physical Therapy from Maryland. She has expertise in the therapeutic areas of orthopedics, neurology, chronic pain, gastrointestinal dysfunctions, and rare diseases especially Ehlers Danlos Syndrome.
Myelofibrosis (MF) is a type of chronic myeloproliferative neoplasm, or blood cancer. Although myelofibrosis is primarily managed by a hematology-oncology specialist, a care team network of providers is often required for treatment and support.
Hematologist-oncologists are physicians who specialize in the diagnosis, treatment, and management of blood cancers, including MF. The fields of hematology and oncology overlap when people develop cancer of the blood.1,2
Hematologist-oncologists at specialty clinics have access to laboratory testing and imaging facilities (as well as corresponding pathologists and radiologists) to help accurately distinguish MF from other blood cancers. With this information, these specialists can customize a treatment plan based on the patient’s type of MF, their risk stratification, and other pertinent factors, such as general health status and comorbidities.2
Common treatment plans for MF may include a combination of chemotherapy, radiation therapy, and/or stem cell transplantation.2
Read more about MF diagnosis
Pharmacists may become part of the care team for patients with MF when they fill and dispense prescription orders for oral chemotherapies, such as Jakafi® (ruxolitinib) and Inrebic® (fedratinib). They also fill prescriptions that help manage MF symptoms and side effects of MF treatments. Oncology pharmacists ensure that the patient receives a maximum benefit with minimal side effects or toxicities, especially from oral chemotherapy drugs. They provide written protocols specific to each oral chemotherapy drug. Some facilities have pharmacists who monitor dosing and patient progress through oral medication adherence programs.3
Read more about MF therapies
Depending on the severity of symptoms and the selected course of treatment, radiation oncologists may participate in the care of patients with MF. One of the predominant clinical features of MF is an enlarged spleen. Radiation to the spleen may be required to manage spleen size or severity of symptoms caused by this complication.4
Radiation oncologists may also treat patients undergoing allogeneic stem cell transplantations. Radiation therapy destroys unhealthy bone marrow before stem cell transplantation, which replaces unhealthy stem cells with healthy blood-forming cells from a donor.4
Read more about MF treatment
Stem Cell Transplant Specialists
Allogeneic stem cell transplantation is the only potentially curative treatment for MF. However, this treatment may cause life-threatening side effects, so the benefit for each patient must outweigh the risks. Stem cell transplantation is typically reserved for patients with intermediate- to high-risk MF.4
Stem cell transplant specialists guide patients with MF through the process, including radiation and immunosuppressive treatments prior to transplant, donor matching, and replacement of unhealthy stem cells with healthy stem cells.4
If a patient’s spleen becomes too large, oncology surgeons may be required to perform a splenectomy for symptom relief.4
Read more about MF surgical management
Infectious Disease Specialists
Infectious disease specialists may treat patients with MF when they develop treatment- or disease-related secondary infections.4 Immunosuppression before and after stem cell transplantation, postsplenectomy sequelae, and MF itself all increase the risk of developing viral, bacterial, or atypical infections in patients with MF.5-7
Nurse specialists, navigators, and practitioners are a vital part of the care team, as they often help with the treatment of patients with MF. They may perform clinical workups and physical assessments, take vitals, help with patient scheduling and coordinating appointments, educate patients and caregivers, provide specialized treatments such as chemotherapy or stem cell transplantation, and assess for treatment-related side effects.4
A multidisciplinary care team at a cancer clinic may include a nutritionist or dietitian to help minimize the weight loss commonly experienced in MF. These practitioners often provide recommendations for healthy, balanced diets that will help restore a patient’s energy, long drained by MF symptoms, such as anemia, or depleted by treatment. This supportive service enables patients to play a proactive role in their own care.4
Read more about MF diet and nutrition
Social workers can help patients with MF attain practical support, including financial assistance, guidance with insurance, resource navigation, and help with other aspects of their patients’ lives that are affected by MF. They also provide emotional support and can give individual counseling or referrals to support groups.4
Receiving a cancer diagnosis may result in increased anxiety, fear, anger, or other emotional responses. Patients diagnosed with MF may benefit from psychological counseling to express their feelings and learn coping mechanisms and stress management techniques.4
Supportive Care Services
Supportive care services may include nutrition, financial assistance, palliative care, home and community support, transitions between care settings, and pain management therapies, including physical and occupational therapy, yoga, guided exercise classes, and low-impact activities that may help ease bone and muscle pain and improve patients’ physical and mental wellbeing.4
- Myelofibrosis. Leukemia & Lymphoma Society. Accessed December 5, 2022.
- Hematology-oncology and blood cancers. Regional Cancer Care Associates. September 30, 2019. Accessed December 5, 2022.
- Effective practices in myelofibrosis programs. Association of Community Cancer Centers. Accessed December 5, 2022.
- Myelofibrosis. Nebraska Hematology Oncology. Accessed December 5, 2022.
- Stem cell or bone marrow transplant side effects. American Cancer Society. Updated March 20, 2020. Accessed December 5, 2022.
- Petrescu D, Gold WL, Leis JA. Reducing the risk of infection in a patient who will undergo splenectomy. CMAJ. 2012;184(9):1053-1054. doi:10.1503/cmaj.120159
- Mughal TI, Vaddi K, Sarlis NJ, Verstovsek S. Myelofibrosis-associated complications: pathogenesis, clinical manifestations, and effects on outcomes. Int J Gen Med. 2014;7:89-101. doi:10.2147/IJGM.S51800
Reviewed by Hasan Avcu, MD, on 12/6/2022.