Training for a Marathon: Managing Health After an MPN Diagnosis

CURE, 2021 Rare Cancers Special Issue, Volume 9,

Maintaining health before and after a diagnosis of myeloproliferative neoplasms could help patients as they undergo treatment.

Because disease of blood vessels in the heart and elsewhere can affect the efficacy of treatment for patients with myeloproliferative neoplasms (MPNs), staying in close contact with a primary care team is extremely important.

“If you have ... badly controlled diabetes and your cholesterol is bad, chances of something happening go up. That means the chances of getting ... to a (bone marrow) transplant successfully might go down,” said Dr. Raajit Rampal, clinical director of the leukemia service at Memorial Sloan Kettering Cancer Center in New York City, in an interview with CURE®.

Routinely seeing a primary care team ensures that these controllable, treatable issues are managed.

“If a patient is diagnosed with an MPN, it’s important that they recognize that their general health plays a contributing role (in) how they’re going to do with (the) disease and how we may be able to treat (it) or not treat (it),” he said.

MPNs are types of blood cancer that begin with a mutation in a stem cell in the bone marrow, leading to an excessive and abnormal production of any combination of white cells, red cells and platelets, according to the Leukemia & Lymphoma Society.

Thrombotic and cardiovascular events occur in a minority of patients with MPNs, but the results can be devastating and even affect the efficacy of treatment, said Rampal. For example, those who develop thrombosis could see minor blood clots in the leg — but in more severe cases, a clot could also lead to stroke.

He also noted that preexisting risks, such as badly controlled diabetes or heart disease, could prompt health care teams to start treatment for MPNs earlier because the patient is already at a higher risk for developing complications.

When a patient receives a diagnosis of MPNs, “it’s important to consider that diagnosis in the context of that patient’s entire ongoing medical care,” Rampal explained. “One of the things I always emphasize to (my) patients is that all the other parts of their health become magnified.”

Smoking, obesity, diabetes, high blood pressure, high cholesterol, poor diet and lack of movement are all comorbidities that, if not managed, can increase the risk of developing both thrombotic and cardiovascular complications such as blood clots, stroke and heart disease — especially in patients with MPNs.

The cause of this increased risk is still unknown, although experts speculate that it may be due to genetic mutations associated with MPNs, such as a JAK2 gene mutation, which leads to uncontrolled blood cell production. Rampal noted that he considers this “one of the most important questions in MPN."

Rampal said his observations on overall health and patients with MPNs are drawn from the results of an epidemiological study of patients in the United Kingdom with an MPN that examined thrombotic and cardiovascular risks, as well as how the risks were managed in primary care. Findings demonstrated that patients with MPNs were often not prescribed the appropriate medications to manage cardiovascular and thrombotic risks, despite somewhat elevated rates of smoking and stroke. Results from this study were recently presented at the European Hematology Association 2021 Virtual Congress.

“I always tell (my patients with MPNs) it’s sort of like training for (a) marathon” because of the long course of the disease, Rampal explained. “Dealing with a blood condition is absolutely important, but making sure that you’re getting your blood pressure checked regularly, that you’re getting your cholesterol checked, that you are maintaining your weight, that you’re not smoking, that you’re exercising — all of those fundamental things are part of the care of (patients with MPNs).”

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