How Is Myelofibrosis Treated?

Medically Reviewed by Melinda Ratini, MS, DO on February 10, 2023
4 min read

Myelofibrosis (MF) treatment is based on your symptoms. If you don't feel bad right now, you may be able to just watch and wait without treating your cancer. Regular checkups and blood tests will make sure you don't have complications like anemia or an enlarged spleen.

MF affects everyone in different ways. Things like your age, blood cell counts, levels of immature blood cells called blasts, and symptoms like anemia or severe weight loss can help your doctor plan your treatment.

One way to do this is to rank your risk of serious health problems using a scoring formula. Based on your results, you and your doctor will decide which approach is best for you. That includes waiting until you have symptoms to start treatment.

The drugs fedratinib (Inrebic), pacritinib (Vonjo), and ruxolitinib (Jakafi) are approved to treat MF. Most people with MF have a mutation, or change, in one of their genes that tell their body how to make blood cells. These inhibitors are used to block the processes of those faulty genes. The medications can ease some MF symptoms like an enlarged spleen, bone pain, itching, and night sweats. But they can have side effects, like a decrease in platelets or making your anemia worse. You might also have bruising, dizziness, or headaches.

Only through a process called allogeneic stem cell transplantation. In MF, your stem cells don't work like they should. This causes scar tissue to build up in your bone marrow. During this treatment, you're given healthy stem cells from a donor to replace your faulty ones.

Before you start, you'll need high doses either of chemotherapy or radiation to destroy the cells in your bone marrow. Then the donor's healthy stem cells go into your body. If all goes well, the transplanted stem cells start working in your bone marrow to produce healthy blood cells.

This transplant is risky, and the dangers rise as you get older. So you should only try it if you have a high chance of complications from your MF. The new stem cells may attack your body. You might hear a doctor call this "graft versus host disease." It can be life-threatening. The transplant could also damage your organs or blood vessels, cause cataracts, or lead to other types of cancer.

With anemia, your body has too few red blood cells. These treatments can help:

Androgen therapy. Your doctor might give you a man-made version of the male hormone androgen to help raise red blood cell counts and ease anemia symptoms. It can cause side effects like liver damage, and in women, changes such as body hair growth or hair loss.

Blood transfusions. These can give you more red blood cells and ease symptoms from severe anemia.

Chemotherapy. The chemotherapy drug cladribine (Leustatin), helps with anemia symptoms, but it can also make you more likely to get infections and have trouble getting your blood to clot.

Erythropoietin. An injection of the hormone epoetin alfa (Epogen, Procrit) helps you make more red blood cells. This treatment could make it more likely for you to get blood clots.

Immunomodulators. Blood cancer drugs like lenalidomide (Revlimid) and thalidomide (Thalomid) treat anemia in MF. They, too, have side effects, including diarrhea, itching, joint pain, muscle cramps, and nausea. And they lower the type of blood cells that help you fight off infections. They may also cause severe to fatal birth defects, so don't take them if there is any chance you may become pregnant.

Interferon alfa-2a. Your doctor might try injections of these man-made versions of cells your body creates to fight tumors. It could cause depression or worsen problems like diabetes, immune disorders, and thyroid conditions.

Steroids. Steroid medications treat severe anemia, but long-term use might cause your bones to thin or raise your blood sugar and blood pressure.

If MF causes your spleen to swell, you might feel severe pain and bloating. There are a few ways to treat this:

Interferon alfa-2a. Injections may help with this condition.

Chemotherapy. Drugs like hydroxyurea (Droxia, Hydrea, Siklos), interferon alfa, or ruxolitinib (Jakafi) can help shrink your spleen and ease your pain. Hydroxyurea isn't good for you if you have severe anemia, and it could cause skin ulcers. 

Radiation. If surgery isn't a good option for you, you might try radiation, like X-rays, to reduce the size of your spleen.

Surgery. You may need to have your spleen removed, a procedure called a splenectomy. Risks include infection, bleeding inside your body, or blood clots that could affect your lungs or cause a stroke. Some people may get an enlarged liver after spleen removal or make too many platelets, which could cause blood clots. The drug anagrelide (Agrylin) helps lower platelets after spleen surgery. Side effects include headaches or rapid heartbeat.

Yes. Natural approaches could ease your symptoms or just help you manage your disease. While they won't treat or cure your cancer, they could help you feel better overall. Talk to your doctor before you try any of them.

Supplements like iron, folic acid, or vitamin B12 supplements may help you ease anemia symptoms by replacing lost nutrients.

Meditation, yoga, exercise, or socializing with friends could help you reduce stress. Try peppermint tea to ease nausea from chemotherapy.

Seek counseling from a therapist to help you cope with having cancer. Talking to other people who have the disease or their caregivers may help you handle yours better, too. The Leukemia and Lymphoma Society and American Cancer Society both offer online support and local groups.