NCCN Guidelines for Patients® | Myeloproliferative Neoplasms

50 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 Supportive care Guide 9 lists some of the supportive care needs of people with MF. Supportive care doesn’t aim to treat cancer but aims to improve quality of life. It is sometimes called palliative care. Anemia Your doctor will first assess for causes of anemia other than MF. Common causes include bleeding, breakdown of red blood cells, and low iron, B12, or folate levels. If present, these causes should be treated. Standard treatment of anemia with symptoms is a red blood cell transfusion. The donated blood should be processed to remove most white blood cells. This will help prevent the donated blood from attacking your body. It also prevents you from getting CMV ( c yto m egalo v irus). Additional treatment options are based on EPO levels. There are two options if EPO <500 mU/mL. One is ESAs ( e rythropoiesis- s timulating a gents) and the other is a clinical trial. ESAs include darbepoetin and epoetin. These medicines do not work if transfusions are often needed for anemia. 5 Myelofibrosis Supportive care Guide 9. Supportive care Health conditions What are the options? Anemia Everyone ◦◦ Red blood cell transfusions If EPO <500 mU/mL ◦◦ ESAs ◦◦ Clinical trials If EPO ≥500 mU/mL ◦◦ Danazol ◦◦ Other androgen ◦◦ Lenalidomide, thalidomide, or pomalidomide ± prednisone ◦◦ Clinical trial Iron overload • Iron chelation Bleeding or low platelet counts • Platelet transfusions • Antifibrinolytic agents if transfusions fail Infections • Vaccinations • Antibiotics for recurrent infections • G-CSF or GM-CSF for recurrent infections when neutrophils are low Tumor lysis syndrome • Drink lots of water (hydration) • Allopurinol or rasburicase to reduce uric acid Heart (cardiovascular) disease • Counseling and treatment High blood counts in PMF • Cytoreductive therapy