title: Choosing between stem cell therapy and drugs in myelofibrosis.
abstract: Optimal clinical management of patients with primary myelofibrosis and post-essential thrombocythemia/polycythemia vera myelofibrosis is a challenge, given the typically advanced age of presentation and variability of the disease course and prognosis. Current medical therapeutic options have not demonstrated an impact on the disease course, which exceeds the palliation of disease-related extramedullary hematopoiesis and alleviation of cytopenias. In contrast, allogeneic stem cell transplantation (SCT) can lead to 'cure' but is limited due to patient's age or comorbidities. Currently, in patients, who are reasonable candidates, SCT (frequently with a reduced intensity conditioning regimen) is employed for intermediate- to high-risk disease. Current pharmaco-medical therapy is used as a bridge to transplant, or instead of transplant in poor transplant candidates. Pathogenetic insights, especially the discovery of the Janus kinase (JAK)2(V617F) mutation, have ushered in a host of new potential therapeutic agents that may augment the role of medical therapy. Similarly, the boundaries of transplantation continue to alter with strategies that decrease conditioning-related toxicity, improved antimicrobial prophylaxis and decreased graft-versus-host disease. The potential for continued improvements in both medical and transplant therapy suggests that for the immediate future the optimal choices for an individual patient will remain potentially volatile and present complex decisions.
authors.affiliation: Department of Stem Cell Transplantation, University Hospital Hamburg-Eppendorf, Hamburg, Germany. nkroeger@uke.uni-hamburg.de
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.forename: R A
authors.initials: RA
authors.lastname: Mesa
mesh_terms: D000328:Adult; D000728:Androgens / Q000627:therapeutic use; D002986:Clinical Trials as Topic / Q000706:statistics & numerical data; D054697:Cytostatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D019468:Disease Management; D015507:Drugs, Investigational / Q000627:therapeutic use; D004921:Erythropoietin / Q000627:therapeutic use; D000068800:Etanercept; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D053614:Janus Kinase 2 / Q000235:genetics; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010166:Palliative Care; D011087:Polycythemia Vera / Q000188:drug therapy / Q000601:surgery; D055728:Primary Myelofibrosis / Q000188:drug therapy / Q000235:genetics / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012306:Risk; D013920:Thrombocythemia, Essential / Q000188:drug therapy / Q000601:surgery; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000728:Androgens; D054697:Cytostatic Agents; D015507:Drugs, Investigational; D007074:Immunoglobulin G; D019653:Myeloablative Agonists; D018124:Receptors, Tumor Necrosis Factor; D004921:Erythropoietin; C507924:JAK2 protein, human; D053614:Janus Kinase 2; D000068800:Etanercept