Treatment strategies and survival after ruxolitinib discontinuation in myelofibrosis patients: The Italian RUX-MF multicenter study

Myelofibrosis (MF) is a BCR::ABL negative chronic myeloproliferative neoplasm (MPN) characterized by progressive bone marrow fibrosis, leading to impaired hematopoiesis, cytopenias, splenomegaly, and debilitating symptoms such as fatigue, night sweats, and weight loss. These features significantly impact quality of life and contribute to a reduced life expectancy. The introduction of ruxolitinib, a JAK1/JAK2 inhibitor, marked a major advancement in the treatment of MF, offering symptom relief, reduction in spleen size, and improved overall survival (OS). However, ruxolitinib is not curative and becomes less effective over time for most patients. Many eventually require discontinuation due to resistance and/or intolerance, at which point OS is significantly reduced, highlighting the need for effective post-ruxolitinib treatment strategies. To address this issue, we report the findings from a retrospective cohort of 397 MF patients who discontinued ruxolitinib in chronic phase, with a particular focus on the impact of subsequent therapies on survival.