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**Imetelstat + ruxolitinib** is a combination regimen currently under investigation for the treatment of myelofibrosis. Imetelstat is a first-in-class, direct, and competitive inhibitor of telomerase, acting by binding to the RNA template component of telomerase and blocking its enzymatic activity, leading to telomere shortening, apoptotic cell death, and selective inhibition of malignant stem and progenitor cells[2][4][6]. Ruxolitinib is a small molecule inhibitor of Janus kinase 1 and Janus kinase 2, reducing inflammatory cytokine signaling and splenomegaly in myelofibrosis. Combination therapy seeks to leverage ruxolitinib’s symptom control and imetelstat’s potential disease modification against malignant clonal stem cells[1][3][5]. This combination is being evaluated in the IMproveMF Phase 1/1b clinical trial for patients with intermediate-1, intermediate-2, or high-risk myelofibrosis[3][5].
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