title: Controversies and dilemmas in allogeneic transplantation for myelofibrosis.
abstract: JAK1/2 inhibitors have broadened the therapeutic options in myelofibrosis. Though not curative, they result in a meaningful clinical benefit with relatively fewer side effects. In contrast, allogeneic hematopoietic cell transplantation (HCT) is a potentially curative option, but is associated with significant morbidity and mortality. Hence, an important question is the optimal timing of HCT in the era of JAK inhibitors. Timing of HCT is a crucial decision, and need to be individualized based on the personal preferences and goals of therapy; in addition to patient, disease, and transplant related factors. Risk stratification by the currently established prognostic scoring systems need to be further refined by incorporation of prognostically significant mutations to guide the treatment choices better. Data on use of JAK inhibitors prior to HCT have just started to emerge. We discuss some of the current controversies and dilemmas in transplantation for myelofibrosis based on a few real life scenarios.
authors.affiliation: Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center and University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shanavas
authors.affiliation: Allogeneic Blood and Marrow Transplant Program, Princess Margaret Cancer Center and University of Toronto, 610 University Avenue, Toronto, Ontario, M5G 2M9, Canada. Electronic address: vikas.gupta@uhn.ca.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002471:Cell Transformation, Neoplastic / Q000187:drug effects / Q000235:genetics / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053614:Janus Kinase 2 / Q000235:genetics; D008875:Middle Aged; D009154:Mutation; D057285:Precision Medicine; D055728:Primary Myelofibrosis / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; C507924:JAK2 protein, human; D053614:Janus Kinase 2
keywords: CALR mutation; JAK inhibitors; allogeneic transplantation; leukemic transformation; myelofibrosis; prognosis