Myelofibrosis (MF)

Myelofibrosis (MF) is a rare blood cancer characterized by progressive scarring or fibrosis of the bone marrow that interferes with the production of healthy blood cells.¹ 

Common signs and symptoms of the condition include: 

• Anemia, which causes fatigue and shortness of breath; 
• Enlargement of the spleen or liver due to extramedullary hematopoiesis; and
• Constitutional symptoms such as fever, fatigue, weight loss, night sweats, pruritus, bone pain, and loss of appetite.^1,2

Considerations for Myelofibrosis Diet and Nutrition

Although no specific diet has been recommended for patients with MF or other myeloproliferative neoplasms (MPNs), including polycythemia vera (PV) and essential thrombocythemia (ET), many factors may influence the dietary and nutritional recommendations for this patient population, including^3,4:

• High or low blood cell counts due to MF;
• Inflammation;
• Weight gain due to specific medications or treatments;
• Weight loss caused by inflammation or an enlarged spleen, or occurring as a constitutional symptom; and
• Early satiety or fullness from an enlarged spleen or liver.

Read more about MF signs and symptoms

Supplementation for Anemia and Other Deficiencies

Supplementation with vitamin B12, folate, and iron may reduce the risk of anemia in patients with deficiencies of these vitamins and minerals.⁴

In the 2016 Survey of Integrative Medicine in Myeloproliferative Neoplasms (SIMM), 42.8% of patients with MF were using natural products as supplements. Most patients reported taking supplements to support their general health, correct nutritional deficiencies, manage disease-related or non-MPN-related symptoms, manage MPN directly, or for other reasons.⁵ 

The only supplement that affected MPN-related symptoms, evidenced by lower scores on the MPN-Symptom Assessment Form Total Symptom Score (MPN-SAF TSS) and a lower body fat index, was omega-3 fatty acid. Vitamin D, multivitamins, calcium, and magnesium did not affect the MPN symptom burden, fatigue, depression, or patient quality of life.⁵ 

A study of mice published in 2019 indicated that vitamin D receptor-mediated signaling skews macrophage differentiation, resulting in the initiation of myelofibrosis and consequent osteosclerosis. The researchers showed that interference with vitamin D receptor-mediated signaling pathways and a diet low in vitamin D prevented the onset of MF in mice without MF who received MF-positive hematopoietic stem cell transplants. Targeting vitamin D receptor signaling or maintaining a diet low in vitamin D may therefore be a therapeutic intervention for humans with MF.⁶

Read more about MF treatment

Anti-Inflammatory Diet

Elevated cytokine levels contribute to the pathogenesis and progression of MF and correlate with patient responsiveness to treatment.⁷ 

A systemic proinflammatory environment affects the presentation and severity of symptoms, blood cell counts, blood clotting, organ dysfunction, and nutrition.⁴ Therefore, the consumption of foods known to increase inflammation may exacerbate MF symptoms and complications.³ 

The NUTRIENT survey, conducted in 1300 patients with MPNs, analyzed their dietary habits and preferences and their association with disease-related symptoms. Sugary foods and beverages, refined or processed foods, and fried foods increased the symptom burden.⁴

Another study reported that individuals between the ages of 50 and 71 years (the age range in which MPNs are most frequently diagnosed) who consumed higher amounts of sugar were at an increased risk for the development of PV.⁸

It is recommended that patients with an MPN, including MF, adhere to an anti-inflammatory diet, including⁴:

• Avoiding, or consuming in limited amounts, foods that are processed and refined, such as boxed sweets, fast foods, and sugary snacks or beverages; and
• Consuming foods with anti-inflammatory effects, such as fruits, vegetables, whole grains, nuts, and oily fish.

Excessive alcohol consumption may aggravate MF-related anemia and bone marrow abnormalities.⁹ Alcohol also increases gastrointestinal and systemic inflammation and may contribute to liver and organ damage.¹⁰ Enlargement of the liver due to extramedullary hematopoiesis occurs in 60% to 70% of patients with MF, and approximately 10% to 18% present with portal hypertension.¹¹

A healthful, balanced diet can help control weight, decrease widespread inflammation, support the immune system, and decrease fatigue in patients with MF.³

Read more about MF etiology

Dietary Recommendations for Splenomegaly or Hepatomegaly

Nearly 90% of patients with MF have splenomegaly.¹¹ Patients with MF and splenomegaly or hepatomegaly may experience early satiety or fullness during meals, decreased appetite, or vague abdominal discomfort just below the rib cage.^4,12 Early satiety is especially common in patients with massive splenic enlargement from gastric displacement.¹²

Dietitians or nutritionists may devise strategies for timing the frequency of meals to prevent early satiety, nausea, and discomfort during meals. Smaller, more frequent, and balanced meals throughout the day may prevent weight loss or malnutrition due to enlargement of the spleen or liver.⁴

Read more about MF complications

References

1. Primary myelofibrosis. MedlinePlus. Accessed December 23, 2022.
2. Mesa RA, Schwager S, Radia D, et al. The Myelofibrosis Symptom Assessment Form (MFSAF): an evidence-based brief inventory to measure quality of life and symptomatic response to treatment in myelofibrosis. Leuk Res. 2009;33(9):1199-1203. doi:10.1016/j.leukres.2009.01.035
3. Myelofibrosis and nutrition. MassiveBio. Accessed December 23, 2022.
4. Scherber R, Mesa R, Eckert R. Nutrition recommendations for MPN patients. Mays Cancer Center at UT Health San Antonio. Accessed December 23, 2022. 
5. Gowin K, Langlais BT, Kosiorek HE, et al. The SIMM study: survey of integrative medicine in myeloproliferative neoplasms. Cancer Med. 2020;9(24):9445-9453. doi:10.1002/cam4.3566
6. Wakahashi K, Minagawa K, Kawano Y, et al. Vitamin D receptor-mediated skewed differentiation of macrophages initiates myelofibrosis and subsequent osteosclerosis. Blood. 2019;133(15):1619-1629. doi:10.1182/blood-2018-09-876615
7. Fisher DAC, Miner CA, Engle EK, et al. Cytokine production in myelofibrosis exhibits differential responsiveness to JAK-STAT, MAP kinase, and NFκB signaling. Leukemia. 2019;33(8):1978-1995. doi:10.1038/s41375-019-0379-y
8. Podoltsev NA, Wang X, Wang R, et al. Diet and risk of myeloproliferative neoplasms in older individuals from the NIH-AARP cohort. Cancer Epidemiol Biomarkers Prev. 2020;29(11):2343-2350. doi:10.1158/1055-9965.EPI-20-0592
9. Ballard HS. The hematological complications of alcoholism. Alcohol Health & Research World. 1997;21(1):42-52. 
10. Bishehsari F, Magno E, Swanson G, et al. Alcohol and gut-derived inflammation. Alcohol Res. 2017;38(2):163-171.
11. Lal A. Primary myelofibrosis clinical presentation: physical examination. Medscape. Updated September 21, 2022. Accessed December 23, 2022.
12. Franklin RA. Splenomegaly clinical presentation. Medscape. Updated June 8, 2022. Accessed December 23, 2022.

Reviewed by Harshi Dhingra, MD, on 12/30/2022.

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Maria Arini Lopez, PT, DPT, CSCS, CMTPT, CIMT

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.