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Rapid and long-lasting decrease of T-regulatory cells in patients with myelofibrosis treated with ruxolitinib

Leukemia volume 28, pages 449–451 (2014)Cite this article

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Myelofibrosis (MF) is a clonal disorder of the hematopoietic stem cells characterized by variable degree of bone marrow fibrosis, increased number of circulating CD34+ progenitor cells, splenomegaly and an increased risk of leukemic transformation.1 Various immune-related abnormalities, ranging from isolated altered laboratory values to overt clinical (auto-)immune diseases, have been reported in a large number of patients with MF.2, 3

Ruxolitinib, a small-molecule JAK1/2 inhibitor, is considered effective and safe in the relief of splenomegaly and systemic symptoms in MF,4 and it is now approved for this use in US and EU. Since 2009, we have treated 47 patients with MF enrolled in two consecutive clinical trials with ruxolitinib (ClinicalTrials.gov Identifiers: NCT001493414 and NCT00934544) or under an individual patient therapeutic use. Of these patients, one developed tuberculosis,5 two herpes zoster infections, two herpes simplex reactivation and one non-bacterial pneumonia of suspected viral origin. This incidence of infectious adverse effects is in agreement with the Novartis reported high incidence of urinary tract infections (12.3%), occurrence of herpes zoster (4.3%) and tuberculosis (1%) infections.6 In this line of evidence, Cryptococcus neoformans pneumonia,7 reactivation of hepatitis B virus infection,8 development of bilateral toxoplasmosis retinitis9 and occurrence of progressive multifocal leukoencephalopathy10 in patients with MF receiving ruxolitininb have been described. Therefore, ample rationale exists to investigate the possible role of ruxolitinib in immune surveillance of patients with MF treated with this drug.

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Authors and Affiliations

  1. Biotechnology Research Area, IRCCS Policliico S. Matteo Foundation, Pavia, Italy

    M Massa, V Rosti, R Campanelli, G Fois & G Barosi

  2. Center for the Study of Myelofibrosis, Biotechnology Research Area, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy

    V Rosti, R Campanelli, G Fois & G Barosi

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  1. M Massa
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Massa, M., Rosti, V., Campanelli, R. et al. Rapid and long-lasting decrease of T-regulatory cells in patients with myelofibrosis treated with ruxolitinib. Leukemia 28, 449–451 (2014). https://doi.org/10.1038/leu.2013.296

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