Improving disease burden in myelofibrosis: changing the natural history of the disease.

The review by Kremyanskaya and colleagues[1] regarding the utilization of ruxolitinib (Jakafi) in the therapy of myelofibrosis (MF) raises many important issues regarding how we assess drug efficacy in MF, the heterogeneous nature and impact of the disease, the published data regarding utilization of ruxolitinib, and practical advice for potential prescribers. At its core, the key question posed by the authors is, “What is the aggregate benefit of ruxolitinib in MF: palliation or improvement of the natural history of this disease?”