Can Monitoring Albumin Levels Help Track Myelofibrosis Treatment Success?
How might albumin levels help guide myeloproliferative neoplasm (MPN) care? Expert Dr. Andrew Kuykendall from Moffitt Cancer Center discusses research on albumin monitoring and treatment for myelofibrosis and polycythemia vera, treatment response, spleen size, and proactive patient advice.
[ACT]IVATION TIP
“...monitor your lab work. Use everything at your fingertips to kind of get a sense for how something’s working. So whether it’s albumin level or spleen size or symptoms…really take everything into account to know if the treatment’s working for you.”
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Transcript:
Lisa Hatfield:
Dr. Kuykendall, your research shows that changes in serum or blood albumin levels are linked to better survival in myelofibrosis patients treated with ruxolitinib (Jakafi). How could this information help doctors monitor patient progress and adjust treatment plans over time?
Dr. Andrew Kuykendall:
Yeah, so this is a bit of a passion project for me that I spent a few years looking at. Want to give a little bit of a backstory. Ruxolitinib is a JAK inhibitor that is approved for myelofibrosis as well as polycythemia vera. And what it’s able to do, the way to think about, it’s like a disease-specific anti-inflammatory. And so the disease itself kind of ramps up these inflammatory pathways, ruxolitinib blocks those inflammatory pathways, and it improves patients’ symptoms.
It’s also been able to show kind of reduction in splenomegaly or enlarged spleen for patients, but it doesn’t really get rid of disease, right? So we’d like it to be better than it is. We’d like it to get rid of the bone marrow disease and get so-called complete response or complete remission. But we don’t see that.
However, we know that it helps a lot of patients. And I think that the challenge is knowing when it’s helping someone and when to continue it versus when should you consider alternative options? And we’ve really struggled with kind of coming up with an objective definition of how to kind of define treatment success or failure with this. And so the best data we have supports patients that have a spleen response tend to have better survival than those patients that don’t have a spleen response.
However, we’re not routinely imaging patients’ spleens in the clinic, and many patients it’s difficult to monitor their spleen kind of growth or reduction in size on exam. And so this not isn’t always the most feasible way to monitor kind of response to therapy. And symptoms…they can be variable.
Certainly if patients are feeling better, that’s a great thing, but a lot of things factor into symptoms. And so kind of on a week to week, month to month, visit to visit basis, that may be challenging. And so I was very interested in looking at albumin, which I think kind of factors into a lot of things regarding health. So patients that are more nutritionally optimized have better albumin levels, patients that have less inflammation just in general have better albumin levels and patients that are eating well have better albumin levels.
And actually I kind of harkened back to a trial that was published on ruxolitinib-treated patients that showed that patients who got ruxolitinib, their albumin levels rose over time. And that was intriguing to me, which was the thought was, okay, well if that happens, if this is something specific to ruxolitinib, does this… Is this something that that can actually define those patients that do well?
Does this represent someone who’s able to eat better and be more nutritionally optimized? Does this represent someone who’s getting a really good anti-inflammatory benefit from ruxolitinib? And so we looked at our patients and actually combined our data sets with an Italian data set as well, and showed that those patients on ruxolitinib whose albumin either stayed the same or improved, actually derived a survival benefit compared to those whose albumin levels stayed the…or whose albumin levels decreased over time.
And that was unique to ruxolitinib when we looked at patients who weren’t treated with ruxolitinib, who had myelofibrosis, we didn’t see the same pattern. And so the reason I think this is interesting and potentially clinically relevant, is that we’re always looking at albumin levels. The albumin is involved in kind of the complete metabolic panel or the CMP that we routinely are getting on patients.
And so this is something that’s very available to physicians as they’re watching someone on ruxolitinib. And so they can look and say, oh, look from when they started till now that albumin level has gone up by a certain amount. I think this is someone who actually I do feel comfortable that they’re doing well. And alternatively, maybe it’s someone who’s on ruxolitinib whose albumin level continues to decline. And you may say, think, you may think, hey, this is maybe symbolic of a treatment that may not be doing enough right now.
Lisa Hatfield:
Okay. Thank you. And do you have an [ACT]IVATION tip for that question?
Dr. Andrew Kuykendall:
I think my [ACT]IVATION tip for this one is monitor your lab work. Use everything at your fingertips to kind of get a sense for how something’s working. So whether it’s albumin level or spleen size or symptoms. I think the [ACT]IVATION tip here is really take everything into account to know if the treatment’s working for you.
