Investigating Diet and Nutrition's Effects on MPNs

An ongoing trial is seeking to find out if a patient with an MPN can improve their health status through nutritional interventions. 
Currently, the only way to prevent progression of myeloproliferative neoplasms (MPNs) is through stem cell transplant. However, there are other factors, such as inflammation, that can affect the disease. This leads researchers to believe that diet may play a key role for these patients.
A group of researchers NUTRIENT trial (NUTRitional Intervention among myEloproliferative Neoplasms Trial), which will ultimately help craft dietary interventions for people with MPNs. The study kicked off with an online survey of more than 900 patients with MPNs of which 95 percent said they would be interested in changing their diet if it could change the disease course.
In an interview with CURE, two researchers on the study, Robyn M. Scherber, M.D., Ph.D., fellow at the Oregon Health and Science University and research consultant at the Mayo Clinic in Arizona and Angela Fleischman, M.D., Ph.D., assistant professor in the department of Medicine, Division of Hematology/Oncology at UC Irvine, discussed what the future of nutrition intervention may be for patients with MPNs.

Can you talk about your reasoning behind running this trial?

Essential thrombocythemia (ET), polycythemia vera (PV) and myelofibrosis (MF) are unique types of blood cancers. Unlike many other blood cancers that may take someone’s life in a short timeframe, these diseases, called the myeloproliferative neoplasms (MPNs), can remain unchanged for years and require only minimal treatment. Although treatments are available, these do not ultimately prevent progression of the disease with the exception of bone marrow transplantation. This long disease course gives us a unique perspective to understand how cancers develop over time and gives us an unparalleled opportunity to intervene early in the disease with treatments that are safe and potentially effective.
Inflammation plays a critical role in MPN disease. First, inflammation contributes to the features of the disease that patients experience on a day-to-day basis. This includes disease-related symptom burden and features of the disease such as blood clots, bone marrow scarring and low or high blood counts. Secondly, inflammation contributes to MPN disease progression. Inflammation helps to drive the cancer cells to grow as well as contributes to fibrosis, or scarring of the bone marrow, that can develop over time.  Our most common current therapies for MPNs often impact inflammation, including aspirin, interferon (that has both the role of stimulating as well as suppressing inflammation) and Jakafi (ruxolitinib). There is also some early data in MPN mouse models that over-the-counter anti-inflammatories may impact the disease course. However, despite these treatments many patients are considered “low risk” and are not eligible for medication treatments. In these patients there remains an unmet need to help control symptoms and reduce inflammation.
What makes us think that diet may be important for MPN patients? Over our years of study, we have found that patients with MPNs can have symptoms that may be specifically impacted by diet. This can include getting full too quickly, abdominal discomfort, nausea and weight loss. We have also found that individuals with MF often have unusually low cholesterol levels and large amounts of weight loss that can negatively impact survival. On the other hand, patients with ET and PV tend to be overweight and that can contribute to the development of inflammation. To date, there have been no studies regarding the diet of MPN patients. In turn, we, as physicians, cannot offer clear recommendations in terms of what the best diet may be for MPN patients or how the dietary needs of MPN patients may differ. When we look at more well-studied diets such as the Mediterranean diet, there is evidence that markers of inflammation as well as markers of abnormal blood clotting in the blood improve. In diseases where there are lots of inflammation, such as inflammatory bowel disease, there have been trials that have demonstrated that a diet that emphasizes low inflammation can not only make patients feel better, but help to improve the disease itself. This got us thinking about the relevance of diet in MPNs. What if we were to look at how a diet low in processed foods and high in foods rich with anti-inflammatory compounds? Could this change not only patients’ symptoms, but help to slow the progression of the disease itself?

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