Ann Mullally, MD: The Team and Tools for MPNs


How do primary care physicians interact with specialists, and what is the current state of care?

Myeloproliferative neoplasms (MPNs) are a chronic and concerning burden to patients, and tasks specialists with engaging care with a full team and a select source of non-invasive therapies.

In an interview with MD Magazine® while at the American Society of Hematology (ASH) 2019 Annual Meeting in Orlando, Ann Mullally, MD, associate professor at Harvard Medical School and a researcher at Brigham & Women’s Hospital, detailed the dynamic she and colleagues set with primary care physicians.

Mullally also shared her perspective on the current state of treatment options available to combat MPNs.

MD Mag: What is the current state of PCP and specialist interaction when it comes to MPNs?

Mullally: So I mean, I can probably only speak to my own experience. So, I think the major time when I interact with primary care doctors is when they detect abnormal blood counts. In particular, like elevated red cell count or elevated platelet count, and they need some guidance as to sort of whether that could be an MPN or not.

And so I think obviously, the primary care doctor is critical in the diagnosis of MPN because many times the patients are not symptomatic, and it's just an incidental finding on a CBC. And it is very important opportunity to pick up on that, follow up, and either refer or send the appropriate diagnostic test to make the diagnosis of MPN.

So, that would be my first typical interaction with a primary care doctor. And then, MPNs are chronic diseases, so patients live with them their entire life, so I establish relationships with primary care doctors as we follow the patients together.

And it's very important that the patients have a good primary care doctor that they see because many issues come up along the way in terms of risks for thromboses in terms of when they need surgeries, infectious risks with some of the treatments.

And so, it's really a partnership between the MPN physician and the primary care doctor, in terms of the management of the patients in the longer term. And as I said, it's a lifelong management. So that's really a partnership between the MPN physician and the primary care doctor.

MD Mag: What is the current state of care for MPNs, and how can it be improved still?

Mullally: The majority of what we do is we institute treatments to reduce the risks associated with these diseases—in particular, the risks of thromboses or cardiovascular events like MI or stroke. So that's really the backbone of our therapies.

And we also have treatments that we institute to help with symptoms, including enlarged spleen in patients with myelofibrosis, or a lot of these systemic symptoms that patients can have—sweats, pruritus, those type of symptoms. And some of our treatments including the JAK2 inhibitors have appear to enhance survival. So, patients live longer with these treatments.

I think our deficiencies are that we don't have a really consistent way to cure these diseases, aside from allergenic stem cell transplantation, which sometimes we use in the context of myelofibrosis, and aside from interferon which in a minority of patients can achieve what we call molecular remission—where we can no longer detect the mutations, the cause of disease.

With those 2 exceptions, we're not curing the diseases we're managing them in patients in the longer term. So, I think we're we've gotten a lot better at managing them. We have a better toolbox now, we have more medicines available, we have more options.

But ultimately, I think the future has to be moving closer towards developing treatments that really have disease-modifying activity and ultimately have the ability to eradicate or cure the disease. That's the goal of my research and the goal of lots of research, of people who work in the field.

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