Of interest to anyone using/considering Peg/INF

[Paul123456]

link.springer.com/article/1...

Very detailed up to date summary of INFs albeit mostly beyond my pay grade. I thought encouraging for those of us on INF/Peg but there still appear to be the two Camps of Hems - pro HU first line and pro INF first line.

For those of us who are TET2 and JAK2 +, this article is a must read. Appears the TET2 mutation implies a poorer prognosis and greater resistance to INF. something I will be discussing with my Hem next visit.

However I thought the most interesting part of the article was the impact of inflammation on the effectiveness of INF/Peg. The article cites smoking as an inhibitor of INFs.

This begs the question, does inflammatory food also inhibit the effectiveness of INFs. I know there are several ongoing MPN targeted anti inflammatory diet trials.

Maz - if you are reading this, would it please be possible to ask the Prof whether there is a chance that an anti inflammatory diet could enhance the effectiveness of INFs?

I appreciate that there is probably no hard clinical evidence but if there is a chance, I can’t see the downside of being pre-emptive. After all, an anti-inflammatory diet pretty much equates to a healthy diet anyway, reduce refined sugars, carbs, processed food etc.

Thanks Paul

[JohnSC]

Hi Paul,

Thanks for the link to the article. It is very interesting and positive in its outlook.

John

[francesb]

Thank you Paul, very interesting to me as I'm Jak2 pos and TET2. Best wishes, Frances.

[flog]

Maz if you are reading this I would also like to know if an anti inflammatory diet is advisable as I have now seen this in various posts.

Thanks for the information Paul

Maurice

[Paul123456]

This part is encouraging - the Danish study results yet to be announced?

The rationales for these combinations have been thoroughly described and discussed in most recent reviews [51, 124, 125, 126, 127, 128], and preliminary results from the first Danish studies are indeed very promising [177, 178]. In patients in the accelerated phase towards leukemic transformation and in patients having transformed to acute myeloid leukemia, the prognosis is dismal [185]. However, even in these stages, IFN-alpha2 may be an option [186] with the potential as monotherapy to revert imminent or overt leukemic transformation [186]. Importantly, recent studies have shown that monotherapy with the DNA-hypomethylator azacytidine [187] may be efficacious in these patients, and combination therapy with a DNA-hypomethylator and ruxolitinib may be even more efficacious [188]. Based upon the above studies of monotherapy with IFN-alpha2 and combination therapy with DNA-hypomethylating agents and ruxolitinib in patients towards or with leukemic transformation, it is intriguing to consider if “triple therapy” (IFN-alpha2 + DNA-hypomethylator + ruxolitinib) may be even more efficacious

[tessa46]

Thanks Paul, my brother in law has mutated from ET, CALR to Acute Myloid Leukaemia, so very much of interest to me. Many thanks.

[Mazcd Partner MPNVoice]

Hi Paul, Prof Harrison has replied: the UK guidelines reflect UK practice and suggest that either HU or IFN should be offered and an individual decision made.

The data on TET2 is based on a small number of patients but definitely makes interesting reading..