A newly reported consensus regarding myelofibrosis (MF) resistant to treatment could determine the next steps for these patients, according to a study recently published in Future Oncology.

“In the absence of evidence-based guidance, this modified Delphi panel reached consensus on a comprehensive set of parameters defining ruxolitinib failure and providing guidance on appropriate transition to next-line therapy for patients with MF receiving ruxolitinib in clinical practice,” the authors wrote.

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This observational study followed a modified Delphi method to assess the opinion of experts on MF resistant to ruxolitinib. The authors investigated the panel’s opinion on 84 different scientific statements in 3 elicitation rounds. A total of 14 experts participated in the first and second rounds, and almost all (n=11) also attended the online consensus meeting. The online discussion revised almost a fourth (24%) of the statements, but all 84 of them achieved consensus.

Arguably the most important takeaway from this study is the definition of ruxolitinib failure in MF, which refers to a patient that classifies into 1 of these 3 categories: progressive disease, ruxolitinib intolerance, or absence of improvement in either symptoms or spleen response, progressive disease. Such scenarios can be determined after at least 3 months of treatment with the maximally tolerated dose.

Moreover, the experts agreed that a lack of spleen response 1 or more months after an initial response in a total of 3 or more months of treatment could also suggest ruxolitinib failure.

On the other hand, regarding actual information and biomarkers that could guide toward the next steps in the management of these patients, the experts reported scarce evidence-based data. Regardless, the panel advised tapering ruxolitinib for at least 2 weeks, followed or not by a second-line drug. 

“This expert panel recommended introduction of steroids prophylactically when tapering of ruxolitinib is started, and immediately at the first sign of Ruxolitinib discontinuation syndrome,” the authors further noted.


Mascarenhas J, Nguyen H, Saunders A, et al. Defining ruxolitinib failure and transition to next-line therapy for patients with myelofibrosis: a modified Delphi panel consensus study. Future Oncol. Published online May 10, 2023. doi:10.2217/fon-2022-1298