Lindsey Lyle on Differentiating MPN Symptoms From Other Health Issues

It can often be difficult for oncology nurses and other clinicians to determine if a patient’s symptoms are related to their myeloproliferative neoplasm (MPN) or another underlying cause, making a detailed medical history extremely important, explained Lindsey Lyle, PA-C, MS, a nurse practitioner who specializes in hematologic malignancies.

“This is a big challenge for nurses, advanced practice providers and physicians alike,” Lyle said in an interview with Oncology Nursing News®.

Common MPN symptoms — including fatigue, bone aches and pains, night sweats, unintentional weight loss, rib pain and feeling full after eating small amounts of food — are relatively broad and can be associated with numerous health conditions, Lyle said, noting that it is important to rule out other possible causes.

To ensure that these symptoms are not related to another cause, nurses must ask patients about their past medical history, other health conditions, changes in medications, and timing of symptoms. Lyle noted that the patient’s primary care physician can also be a good source of information regarding the timing of a patient’s symptoms.

“When a patient does have a diagnosis of an MPN, we certainly can assume that maybe it is the MPN until other contributors have been ruled out,” Lyle said. “So timing of these symptoms is really important; a nurse can ask about when symptoms first started, what they were doing when these symptoms happened and what makes them better, or what makes them worse.”

Additionally, Lyle mentioned that nurses should ask patients about how treatments change their symptoms, as some drugs that are currently used to treat MPNs — such as the JAK inhibitors ruxolitinib (Jakafi), fedratinib (Inrebic), and pacritinib (Vonjo) — can decrease symptoms, such as splenomegaly. In fact, last year, the Food and Drug Administration (FDA) approved pacritinib for patients with intermediate- or high-risk primary or secondary myelofibrosis because the phase III PERSIST-2 trial showed that the drug decreased spleen volume by at least 35% in 29% of patients.¹

Reference

1. Mascarenhas J, Hoffman R, Talpaz M, et al. Pacritinib vs best available therapy, including ruxolitinib, in patients with myelofibrosis: a randomized clinical trial. JAMA Oncol. 2018;4(5):652-659. doi:10.1001/jamaoncol.2017.5818

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