A. Patients with International Prognostic Scoring System (IPSS) intermediate-1 (INT-1) MF derive the greatest reduction in total symptom scores compared to higher risk disease B. Patients starting ruxolitinib with platelets <50K/mm3 required a reduced starting dose to limit the risk of severe thrombocytopenia C. Compared to best available therapy (BAT), ruxolitinib failed to demonstrate a significant difference in spleen size reduction at 24 weeks D. Approximately half of patients treated with ruxolitinib had at least a 50% reduction in MF total symptom scores after 6 cycles of therapy E. Unsure

A. The patient's previous symptom response coupled with <6 months of treatment suggest the patient is unlikely to be failing ruxolitinib and requires longer treatment to enable spleen response B. Inadequate spleen response is a common reason for ruxolitinib failure and is associated with a favorable overall survival compared to other causes of therapy discontinuation C. In the absence of new transfusion requirement or severe thrombocytopenia, the patient would not be considered a ruxolitinib failure and requires longer treatment D. Patients with more severe anemia or thrombocytopenia at the time of ruxolitinib initiation are less likely to discontinue ruxolitinib treatment than patients with higher blood counts E. Unsure

A. Fedratinib is not indicated in this patient as his platelets prior to starting treatment are <100K/mm3; he should instead be treated with ruxolitinib B. The patient should be started on fedratinib 500 mg PO daily initially, as this demonstrated significantly improves symptom control at 6 months compared to 400 mg PO daily C. Prior to starting fedratinib, a thiamine level should be checked and repleted if deficient, to limit risk of Wernicke encephalopathy D. Compared to ruxolitinib, treatment-naïve patients who received fedratinib had significantly higher rates of spleen volume reduction ≥35% after 6 months of treatment E. Unsure

A. In a per protocol analysis of patients previously treated with a JAK inhibitor, fedratinib resulted in ~25% of patients having ≥50% decrease in total symptom score and ~55% having ≥35% reduction in spleen volume B. In patients previously treated with a JAK inhibitor with platelets <100K/mm3, once-daily pacritinib had significantly higher rates of patients obtaining a ≥50% decrease in total symptom score compared to BAT C. In patients previously treated with a JAK inhibitor, momelotinib had significantly higher rates of patients with ≥35% reduction in spleen volume compared to BAT D. In patients previously treated with a JAK inhibitor, imetelstat failed to demonstrate disease-modifying activity as evidenced by inability to reduce marrow fibrosis or reduce JAK2 V617F allele burden E. Unsure

A. Increase ruxolitinib to 25 mg PO BID B. Start fedratinib 400 mg PO daily C. Start pacritinib 200 mg PO BID D. Start momelotinib 200 mg PO daily E. Unsure