How We Manage Myelofibrosis Candidates for Allogeneic Stem Cell Transplantation

Abstract

Moving from indication to transplantation is a critical process in myelofibrosis. Most of guidelines specifically focus on either myelofibrosis disease or transplant procedure, and, currently, no distinct indication for the management of MF candidates to transplant is available. Nevertheless, this period of time is crucial for the transplant outcome because engraftment, non-relapse mortality, and relapse incidence are greatly dependent upon the pre-transplant management. Based on these premises, in this review, we will go through the path of identification of the MF patients suitable for a transplant, by using disease-specific prognostic scores, and the evaluation of eligibility for a transplant, based on performance, comorbidity, and other combined tools. Then, we will focus on the process of donor and conditioning regimens' choice. The pre-transplant management of splenomegaly and constitutional symptoms, cytopenias, iron overload and transplant timing will be comprehensively discussed. The principal aim of this review is, therefore, to give a practical guidance for managing MF patients who are potential candidates for allo-HCT.

Keywords: JAK-inhibitors; allogeneic stem cell transplantation; bone marrow transplantation; deferasirox; iron overload; myelofibrosis; ruxolitinib; splenectomy.

Figure 1

Proposed pre-transplant management of MF candidates to allogeneic stem cells transplantation. IMIDs: immunomodulating agents; RUX: ruxolitinib; MTD: maximum tolerated dose; RBC: red blood cells; SpR: spleen response; NR: no response; PD: progressive disease.