NCCN Guidelines for Patients® | Myeloproliferative Neoplasms

53 NCCN Guidelines for Patients ® : Myeloproliferative Neoplasms, 2018 5 Myelofibrosis Advanced-stage MF or AML Advanced-stage MF or AML Treatment options for advanced-stage MF or AML are listed in Guide 10 . Options are based on whether allogeneic HCT is an option. Allogeneic HCT is not safe for everyone. Most people will not be able to receive it. Your doctor will assess if a transplant is right for you. He or she will consider your age, health, wishes, and other factors. Before a transplant, treatment to cause cancer remission will be given. You may receive hypomethylating agents or intensive induction chemotherapy. Hypomethylating agents include azacitidine and decitabine. If you can’t receive a transplant, you may have two options. One option is to join a clinical trial. The second option is to receive hypomethylating agents or low-intensity induction chemotherapy. These treatments may reduce symptoms. If treatment works well, allogeneic HCT may become an option. Review † † PMF occurs in the absence of prior bone marrow problems. ET and PV can progress to MF. This disease is respectively called post-ET myelofibrosis and post-PV myelofibrosis. † † A key feature of MF is scarring of the bone marrow. Scar tissue may cause blood cell counts to drop. Scarring may not be present in early MF. † † Treatment options are based on risk group. Observation is an option for low- and intermediate-1-risk cancers without symptoms. If symptoms are present, ruxolitinib or cytoreductive treatment may be an option. Allogeneic HCT is an option for high-risk MF. † † Besides cancer treatment, you may receive supportive care to prevent or reduce symptoms related to the cancer. † † You will need to meet with your doctor often. He or she will assess the status of the cancer and how you feel. † † If the cancer is getting worse, you may receive allogeneic HCT. Other options are joining a clinical trial and hypomethylating agents or chemotherapy to reduce symptoms. Guide 10. Treatment for advanced MF or AML Transplant status What are the options? Allogeneic HCT is an option • Hypomethylating agents or intensive induction chemotherapy followed by allogeneic HCT Allogeneic HCT is not an option • Clinical trial • Hypomethylating agents or low-intensity induction chemotherapy