A Predictive Model for Response in Myelofibrosis Patients Treated with JAK2 Inhibitors: A Study from Three US Academic Centers and a Large Industry-Based Cohort

Abstract

Background: JAK2 inhibition improves splenomegaly and symptoms in patients with myelofibrosis (MF), and the JAK2 inhibitor ruxolitinib has been shown to improve both bone marrow fibrosis and survival in MF patients (Cervantes et al., 2013; Verstovsek et al., 2013). Current prognostic models such as DIPSS plus (Gangat et al., 2011) predict survival in MF based on clinical, laboratory, and cytogenetic information, but predate the era of JAK2 inhibitor use in MF. As such, their value in predicting clinical response or survival during treatment with JAK2 inhibitors remains unknown. We hypothesized that features not considered by DIPSS plus, including bone marrow fibrosis and splenomegaly, have independent effects on therapy response. We therefore conducted a retrospective analysis to create a new model to risk stratify patients with respect to their likelihood of achieving a > 50% reduction in splenic size by palpation with JAK2-inhibitor therapy.Methods: We studied a cohort of 418 patients with bone marrow biopsy-proven MF who were treated with ruxolitinib or one of four other JAK2 inhibitors. An initial cohort of 203 patients seen at University of Michigan, Stanford University, and Mayo Clinic in Scottsdale, AZ was used identify factors that would predict a clinical response to therapy. Response to therapy was evaluated at an early time point (3-4 mos) in 167 patients and at a late time point (5-12 mos) in 138 patients, with 127 patients overlapping between the two. We constructed a multivariable logistic regression model, with Bayesian variable selection, for predicting the probability of early or late splenic response to JAK2 inhibitor therapy. The model was developed with this initial group of 203 patients. The model was then validated with a cohort of 215 patients from the PERSIST1 trial (data supplied by CTI Biopharma).Results:Conclusion: We identified several factors that play a role in predicting whether or not patients with MF are likely to respond to JAK2 inhibitor therapy. The interaction between spleen size and WBC at the time of therapy initiation plays the strongest role in predicting which patients will have an early response to therapy. Additionally, our model suggests that patients who do not have a response to JAK2 inhibitor therapy by about 4 months of treatment are unlikely to develop a later response. Our model is able to discriminate between those likely to benefit after several months of therapy and those for whom a change in therapy should be considered early in their treatment course. [Display omitted] [Display omitted] DisclosuresBoonstra:CTI Biopharma: Research Funding. Gowin:Incyte: Membership on an entity's Board of Directors or advisory committees. Mesa:Novartis: Consultancy; Ariad: Consultancy; Promedior: Research Funding; Celgene: Research Funding; Galena: Consultancy; Incyte: Research Funding; CTI Biopharma: Research Funding; Gilead: Research Funding. Talpaz:Ariad: Other: Expense reimbursement, travel accomodation expenses, Research Funding; Novartis: Research Funding; Incyte Corporation: Other: Travel expense reimbursement, Research Funding; Pfizer: Consultancy, Other: travel accomodation expenses, Research Funding.