Myelofibrosis: response to busulfan after hydroxyurea failure.

We report a case of myelofibrosis with myeloid metaplasia (MMM) that responded dramatically to oral busulfan treatment after failure of hydroxyurea. Although busulfan treatment of this disease has fallen out of favour due to the favourable toxicity profile of hydroxyurea and reports of efficacy of interferon-alpha, our observation suggests there may still be a role for busulfan treatment of MMM in the setting of hydroxyurea or interferon failure or intolerance.