title: Allogeneic hematopoietic cell transplantation for myelofibrosis in patients pretreated with the JAK1 and JAK2 inhibitor ruxolitinib.
abstract: The Janus-activated kinase 1 (JAK1) and JAK2 inhibitor ruxolitinib is effective in decreasing symptomatic splenomegaly and myelofibrosis (MF)-related symptoms. However, allogeneic hematopoietic cell transplantation (HCT) remains the only curative option. We evaluated the impact of ruxolitinib on the outcome after HCT. A cohort of 14 patients (median age 58 years) received a subsequent graft from related (n=3) and unrelated (n=11) donors after a median exposure of 6.5 months to ruxolitinib. At HCT, MF risk for survival according to the International Prognostic Scoring System was intermediate-2 or high risk in 86% of patients. Under ruxolitinib, MF-related symptoms were ameliorated in 10 (71.4%) patients and the palpable spleen reduced by a median of 41% in 7 (64%) of 11 patients with splenomegaly. Engraftment occurred in 13 (93%) patients. Acute GvHD grade-III occurred in 2 (14%) patients. Median follow-up was 9 months. Survival, EFS and treatment-related mortality were 78.6, 64 and 7%, respectively. Through the anti-JAK-mediated reduction in both cytokines and splenomegaly as well as improvement in performance status, ruxolitinib might improve outcome after allogeneic HCT in patients with MF. The downregulation of inflammatory cytokines might have a beneficial impact on graft failure and acute GvHD.
authors.affiliation: Division of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Jaekel
authors.affiliation: Division of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Behre
authors.affiliation: Division of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Behning
authors.affiliation: Institute of Pathology, University Hospital of Leipzig, Leipzig, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Wickenhauser
authors.affiliation: Division of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lange
authors.affiliation: Division of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Niederwieser
authors.affiliation: Division of Hematology and Oncology, University Hospital Leipzig, Leipzig, Germany.
authors.forename: H K
authors.initials: HK
authors.lastname: Al-Ali
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009570:Nitriles; D055728:Primary Myelofibrosis / Q000628:therapy*; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000009:adverse effects; D011720:Pyrazoles / Q000494:pharmacology / Q000627:therapeutic use*; D011743:Pyrimidines; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods*
chemical_list: D009570:Nitriles; D047428:Protein Kinase Inhibitors; D011720:Pyrazoles; D011743:Pyrimidines; C540383:ruxolitinib