Treatment for MPN

Treatment looks different for different people, depending on your diagnosis. We tailor your treatment plan to you. 

Our myeloproliferative neoplasm (MPN) specialists work closely with you, your family and each other to get you back to health. At Fred Hutchinson Cancer Center, we provide all standard therapies for MPN and offer you access to the latest innovations through clinical trials.  

Treatment Plan

MPN treatment at Fred Hutch is highly customized for each patient’s needs. 

How Do We Create Your Treatment Plan?

Your hematologist-oncologist works with an entire group of MPN specialists. They include other hematologist-oncologists and researchers who are looking for better ways to treat this disease.

Every week, this team gathers to discuss their patients’ treatment plans. This approach means each patient benefits from the experience of the whole group.

With support from the larger team, your physician will:

  • Decide if your MPN needs treatment now, and if not, when treatment should happen
  • Talk about the standard therapy for your type of MPN
  • Find out if any clinical trials match your needs so you can think about joining them

Your hematologist-oncologist will walk you and your caregiver through the treatment plan that has been recommended for you. You will have a chance to share your personal preferences and options, and you will decide together what happens next.

Why Do Treatment Plans Differ?

The treatment plan we design for you depends on many things, including:

  • Your MPN subtype
  • Your age and overall health
  • Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial

What Is The Standard Therapy For MPN?

There is no one way to treat everyone. Some people need infusions or other medications. Other people need chemotherapy. They might need a bone marrow transplant. Or they may not need any active treatment for years, but they should be carefully monitored over time. This is called watchful waiting.

At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling and physical therapy.

Our patients can also choose to have promising new MPN therapies that you can only get through a clinical trial. Many people come to Fred Hutch for access to these studies. Your care team will tell you about studies that might be right for you, so you can think about joining them.

Treatment Process

Different subtypes of MPN start, progress and respond to treatments in different ways. We choose, combine and schedule your treatments based on what works for your subtype. Your care team makes sure you understand each type of treatment and all your choices.

Watchful Waiting

Some patients do not need treatment right away. With watchful waiting, you will not have any treatment, but you will visit your physician on a regular basis (or if you notice any changes) to check your health. Some people with MPN go for several years with no major health changes. 

Low-Dose Aspirin

Taking low-dose aspirin daily may reduce the risk of blood clots, heart attacks and strokes. It also helps keep platelets from sticking together, which makes it harder for blood clots to form. Low-dose aspirin means 80–100 milligrams of aspirin every day. 

Treatment and Medicines

If you have more serious symptoms, your physician is likely to recommend treatments to control your underlying disease.

In advanced disease and burn-out phases (when your marrow is not making enough healthy blood cells), your physician may recommend steps to reduce symptoms that are caused by low levels of blood cells. For MPN, these steps may include medicines and transfusions.

Phlebotomy

Phlebotomy means removing blood from the body. In MPN, large-volume phlebotomy (usually one unit of blood, or 500 milliliters) is used to lower red blood cell (RBC) counts. This may help with symptoms that are linked with high levels of RBCs. Phlebotomy is also used along with aspirin to reduce clot complications in people with polycythemia vera and low clot risk.

Blood or Marrow Transplant for MDS

If you will need a blood or marrow transplant, a team of Fred Hutch transplant experts will care for you. Your team will include a transplant oncologist, transplant nurse, physician assistant or advanced registered nurse practitioner, pharmacist, registered dietitian, team coordinator and social worker. 

Physicians and researchers at Fred Hutch pioneered blood and marrow transplants decades ago. Today we continue to improve transplant techniques and to develop new options.

Learn more about Blood and Marrow Transplant

Cytoreductive Therapy

These medications reduce the number of blood cells. You might need cytoreductive therapy if you have a new blood clot, major bleeding, frequent phlebotomy treatments, enlarged spleen, high platelet count, high white blood cell count or symptoms that are getting worse.

Hydroxyurea (Hydrea®)

This chemotherapy drug is taken by mouth as a pill or capsule. It is used for high-risk category patients who cannot have frequent phlebotomy treatments and for patients with high blood counts and enlarged spleens. 

JAK Inhibitors, Including Ruxolitinib, Fedratinib, Pacritinib

This drug is a JAK1/JAK2 inhibitor taken by mouth. It is a second-line therapy in adults who have had an inadequate response to, or who cannot take, hydroxyurea. JAK proteins send signals that affect the production of blood cells in the bone marrow. When JAKs send too many signals, your body makes too many blood cells. Ruxolitinib works by blocking the JAK proteins and cutting down on the signals. 

Interferon Alfa-2b (Intron® A) and Interferon Alfa-2a (Roferon®-A) and Their Associated Sustained-Release Preparations, Peginterferon Alfa-2b (PEG-Intron®), Peginterferon Alfa-2a (Pegasys®) and Ropeginterferon Alfa-2b-njft (BESREMi®)

Interferon is a biological agent that boosts the immune system to fight the production of too many red blood cells. It may be used for patients who are either intolerant or resistant to hydroxyurea, or for patients that we do not recommend hydroxyurea for.

Anagrelide

This is in a group of medications that are used to slow down the production of platelets. It may be used to lower the risk of blood clots in patients who have thrombocythemia. 

Monitoring Your Health

While you are in active treatment, your MPN care team will see you regularly for exams and tests to check:

  • How well your treatment is working
  • If there is any reason to change your treatment
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling

We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you and what you prefer.

Possible Results of Treatment

Throughout treatment, your care team looks for signs of:

  • Remission: Fewer signs and symptoms of MPN. Partial remission means some signs and symptoms remain, and complete remission means there are no signs or symptoms.
  • Stable disease: No change in the extent or severity. The disease is not going away, but it is not getting worse, either.  
  • Disease progression: The disease is getting worse or spreading.
  • Relapse: The disease, signs or symptoms have come back after they had improved.
  • Refractory disease: The disease does not respond to treatment.

What about “cured”? Sometimes physicians use the word “cured” if you have been in complete remission for at least five years. After five years, cancer is less likely to come back (recur), but recurrence is still possible.

Managing Side Effects

You might be wondering about possible side effects from treatment, like hair loss or nausea from chemotherapy. If you are, it might be helpful to know that many of today’s treatments are more targeted to cancer cells, so they don’t cause as many side effects as standard chemotherapy. 

You are always at the center of everything we do. MPN physicians, nurses and advanced practice providers are here to help prevent or relieve side effects of treatment. 

Get Help with Side Effects

Before you begin treatment, we talk with you about what to expect, based on your treatment plan, and what can help if you do have side effects.

At your appointments, we want you to tell us about any side effects you are having. If you have questions or concerns between appointments, you can call or email us. We will make sure you know how to reach care providers at Fred Hutch after hours, if that is when you need us. 

We have many tools to help you feel better, such as:

  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections
  • Transfusions, steroids and medicines that help the immune system treat low levels of blood cells (low blood counts)
  • Nutrition care and medicines to help with digestive problems
  • Conventional and integrative therapies for pain 

Coping with Side Effects

Common Side Effects

Side effects are different depending on which treatment you get. They also depend on other things, like how strong your immune system is. These are some of the common side effects of MPN treatment:

  • Unusual tiredness (fatigue)
  • Hair loss
  • Higher risk of infection (due to low levels of white blood cells)
  • Anemia (due to low levels of red blood cells)
  • Easy bruising or bleeding (due to low levels of platelets)
  • Problems in your digestive tract, like sores in your mouth, nausea, vomiting, constipation or diarrhea
  • Rash or other skin changes
  • Numbness, tingling or pain from nerve damage (neuropathy)
  • Fever 

Supportive Care Services

Along with treating your MPN, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From registered dietitians to chaplains, we have experts who specialize in caring for people with this condition. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need. 

Learn about Supportive Care Services

Continuing Care

When your disease is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your MPN. They will check your overall health and look for signs that your MPN has come back (signs of recurrence). 

Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over).

Schedule For Follow-up Visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your hematologist-oncologist will base your schedule on many things, including:

  • Which treatments you had and how your disease responded 
  • How the disease and treatments affected you 
  • How long it has been since your treatment ended

Most patients have follow-up appointments for at least five years. Some patients will have follow-up appointments for the rest of their life. It is common to have visits more often in the first months and years after active treatment ends and less often as time goes on.

What Happens at Follow-up Visits

Follow-up for MPN usually means seeing your hematologist-oncologist for a physical exam and having blood tests.

Meet the Myeloproliferative Neoplasms Care Team

MPN Team at Fred Hutch