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News & Press: Ask the Expert

Transplantation In Myelofibrosis 101: An Update

Wednesday, March 6, 2019  

The 'Ask the Expert Series' is an ongoing educational publication connecting questions from Canadian transplant healthcare providers to answers from national or international experts. The goal of this series is to provide an opportunity to help transplant care providers address challenging clinical scenarios.

The next ‘Ask the Expert’ article is now available: 

Transplantation In Myelofibrosis 101: An Update

Dr. Auro Viswabandya, MD, DM (Princess Margaret Cancer Centre, Toronto, Ontario)

Who needs transplant?

Although treatment with JAK1/2 inhibitors (JAKi) has revolutionized management algorithms in patients with MF, JAKi are not curative and do not decrease the risk of leukemic transformation. Cure of MF is currently possible only with allogeneic SCT (SCT). However, SCT is associated with significant morbidity and mortality and traditionally it is offered to patients who are destined to have poor survival based on prognostic risk scores (DIPSS and DIPSS-plus). Median survival of patients with intermediate -2 /high risk groups is usually less than 5 years. So, transplant related morbidity and mortality can be justified for these patient groups as there is an overall survival benefit with transplant. 

However, as our understanding of pathogenesis becoming clearer, the dogma of restricting SCT to only Intermediate-2 / high risk groups is also changing. SCT also can be justified for patients who have transfusion dependent anemia, persistent and progressive thrombocytopenia or abnormal cytogenetics as these group of patients do not do well as shown by DIPSS –plus scoring prognostication. Leukemia transformation (LT) remains as an important parameter in treatment decision. In DIPSS-plus cohort, patients with thrombocytopenia (platelets less than 100 x 10^9/l), persistent peripheral blasts of more than 2% and high risk cytogenetics were independently associated with higher progression to leukemia. Read more...

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