Perspectives on the impact of JAK-inhibitor therapy upon inflammation-mediated comorbidities in myelofibrosis and related neoplasms

Abstract

Chronic inflammation is suggested to contribute to the Philadelphia-chromosome−negative myeloproliferative neoplasm (MPN) disease initiation and progression, as well as the development of premature atherosclerosis and may drive the development of other cancers in MPNs, both nonhematologic and hematologic. The MPN population has a substantial comorbidity burden, including cerebral, cardiovascular, pulmonary, abdominal, renal, metabolic, skeletal, autoimmune, and chronic inflammatory diseases. This review describes the comorbidities associated with MPNs and the potential impact of early intervention with anti-inflammatory and/or immunomodulatory agents such as JAK-inhibitors, statins, and IFN-α to inhibit cancer progression and reduce MPN-associated comorbidity impact. Early intervention may yield a subset of patients who achieve minimal residual disease, thereby likely reducing the comorbidity burden and improving the cost-effective socioeconomic profile.

Keywords::

• chronic inflammation
• comorbidities
• essential thrombocythemia
• interferon-α2
• JAK-inhibitor
• myelofibrosis
• polycythemia vera
• socioeconomic profile
• statins

Financial & competing interests disclosure

The author has participated in advisory board meetings for Novartis A/S and Sanofi. The author has received research grants from Novartis A/S. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Financial support for medical, editorial and graphic design assistance was provided by Novartis Oncology. The author thanks M Hoelzle (Articulate Science, USA) for his assistance with this manuscript.

Key issues

• The Philadelphia-chromosome-negative myeloproliferative neoplasms (MPNs), essential thrombocythemia, polycythemia vera and myelofibrosis, depict a biological continuum with CD34⁺ cells (‘metastatic cancer cells’) egressing the bone marrow resulting in extramedullary hematopoiesis, primarily in the spleen.

• As in numerous different cancers, chronic inflammation is suggested to be critical in the etiology and progression of the MPNs and may play a central role in the development of MPN-related comorbidities as well.

• The MPN population displays a range of comorbidities including cerebral, cardiovascular, pulmonary, abdominal, renal, metabolic, skeletal, autoimmune and chronic inflammatory diseases.

• Given the recent data of the therapeutic use of JAK inhibitors and Peg-IFN-α2 in patients with MPNs, it is highly suggestive that early intervention therapy will result in not only alleviating the severe disease burden, but may also alter the disease course resulting in increased patient survival.

• Proper combinations of JAK inhibitors, Peg-IFN-α2 and/or statins will also address the related comorbidities in patients with MPNs, and, with adequate safety profiles, may likely result in improved patient well-being and positively impact the socioeconomic profile of the MPNs.

Notes