Ruben Mesa, MD: Myelofibrosis Patients Frequently Present Symptoms


Ruben Mesa, MD, director of the Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, discusses the visible symptoms and diagnosis process for patients with myelofibrosis.

Myelofibrosis is a rare cancer, but that doesn't mean it's impossible to diagnose. Ruben Mesa, MD, director of the Mays Cancer Center at UT Health San Antonio MD Anderson Cancer Center, told MD Magazine® that identifiable symptoms are usually visible in patients prior to said symptoms being connected with myelofibrosis.

In addition, primary care physicians are well equipped to refer patients to the appropriate specialists, who can correctly diagnose the cancer before it worsens further.

In an interview with MD Mag while at the American Society of Clinical Oncology (ASCO) 2019 Annual Meeting, Mesa discussed the most frequently visible myelofibrosis symptoms in the patient population. Mesa also elaborated upon the importance of primary care physicians in the process of obtaining a myelofibrosis diagnosis.

MD Mag: What does the myelofibrosis patient population look like, and how often do they present with symptoms?

Ruben Mesa, MD: So, the myelofibrosis patient population in the United States is over 20,000 individuals. When we find the disease, you know, the vast majority of patients have symptoms. They can relate around fatigue—that's by far the most common.

They can be around spleen-related symptoms, abdominal discomfort, sometimes pain, sometimes fullness, sometimes early satiety, and they have a range of what we call constitutional symptoms that we have learned are biologically linked with cytokines in the disease.

So by constitution, that can be inadvertent weight loss, night sweats, fevers, and things of that nature. So when we really look and ask patients, almost all patients have symptoms. Sometimes the symptoms have come on so gradually, they have been unaware of them having come on, or they've attributed them to other things.

Do primary care physicians frequently play a role in the diagnosis or specialist referral?

Primary care physicians play a key role in managing our patients with hematological diseases, including other ones that usually find them at the time of diagnosis. You know, on the myelofibrosis end, maybe the observation of spinal megaly in physical exam, it may be abnormalities in blood count, so that they see either anemia or leukocytosis cells in the peripheral blood.

So they typically don't know necessarily yet what the diagnosis is, prior to a bone marrow evaluation, but they typically do have a sense that there's something going wrong in the hema system cause the symptoms—enlargement of the spleen alone—has a broader differential, so it could include myelofibrosis, but it could include an acute leukemia; it could include a lymphoma; it could include mononucleosis.

There's a broader differential, but primary care physicians clearly play a key role in identifying patients that may have a blood condition and myelofibrosis clearly as one of those that may be found.

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