CMWP-EBMT European survey on allo-HSCT practices for MF

Results from a European survey of high-volume transplant centers (N = 19) performing allogeneic hematopoietic cell transplantation (allo-HCT) for patients with myelofibrosis (MF), conducted on behalf of the Chronic Malignancies Working Party (CMWP) of the European Society for Blood and Marrow Transplantation (EBMT), were recently published in Bone Marrow Transplantation by Rampotas et al. The study aimed to assess how individual transplant centers integrate Janus kinase inhibitors (JAKi) into transplant protocols, manage splenomegaly prior to allo-HCT, and make decisions around transplantation. 

Key data: Management approaches varied considerably across centers. Most centers (68%) routinely initiated JAKis, primarily ruxolitinib (79%), prior to conditioning for splenomegaly reduction and symptom control; 58% of centers continued this treatment throughout conditioning. For ruxolitinib intolerant/resistant patients, 42% of centers indicated that they would switch to another JAKi, while 37% of centers reported that they would proceed to allo-HCT without introduction of a new therapy. The remaining centers favored enrollment into clinical trials or individualized decision-making. The majority of centers (58%) reported that they do not routinely restart JAKi therapy after transplant. Experience with novel agents in the pre-transplant setting, including bromodomain and extra-terminal inhibitors (BETi) and B-cell lymphoma-2 inhibitors (BCL2i), was limited, with 21% and 26% of centers reporting experience with BETis and BCL2is, respectively. JAKi therapy was reported to have a perceived positive impact on transplant timing and outcomes by 79% of centers; however, disease progression during transplantation delays were reported by 58% of centers. 

Key learning: Substantial heterogeneity exists in real-world MF allo-HSCT practice across European centers, encompassing timing decisions, splenomegaly management, and integration of novel therapies. Harmonized, multidisciplinary guidelines are needed to optimize transplant timing and outcomes.