Reversal of Transfusion Dependence by Tumor Necrosis Factor Inhibitor Treatment in a Patient With Concurrent Rheumatoid Arthritis and Primary Myelofibrosis

Tumor necrosis factor alpha (TNF-alpha) is a proinflammatory cytokine with pleiotropic effects. Currently, TNF-alpha inhibitors are approved by the Food and Drug Administration for a number of diseases including rheumatoid arthritis, juvenile idiopathic arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn disease, and ulcerative colitis. We report a patient with seropositive rheumatoid arthritis with concurrent primary myelofibrosis, who had transfusion-dependent anemia and moderate thrombocytopenia that reversed during treatment with adalimumab. Rheumatoid arthritis and myeloproliferative disorder or myelodysplastic disorder often coexist, and treatment with standard immunosuppressants becomes complex. This report adds to the accumulating evidence of the safety of TNF-alpha inhibitors when primary myelofibrosis is present and generates discussion for further exploration of the potential therapeutic benefit of TNF-alpha inhibitors in cytopenias associated with primary myelofibrosis.