International Working Group Publishes Updated Guidelines for HSCT in Myelofibrosis

Researchers working in collaboration with the European Society for Blood and Marrow Transplantation (EBMT) and European LeukemiaNet (ELN) have updated the 2015 guidelines regarding indications for and management of hematopoietic stem cell transplantation (HSCT) in patients with myelofibrosis.

The international working group, led by Nicolaus Kröger, MD, at the University Medical Center Hamburg-Eppendorf in Germany, developed the updates with a “consensus-building methodology after a comprehensive review of articles released from January 2015 to December 2022,” per the summary published in The Lancet Haemotology.

Dr. Kröger and colleagues highlighted the following key recommendations included in the update.

First, patients with primary myelofibrosis with any of the following risk stratifications should be considered for allogeneic HSCT:

• Intermediate-2 or high-risk Dynamic International Prognostic Scoring System criteria score
• High-risk Mutation-Enhanced International Prognostic Score Systems score
• Low-risk or intermediate-risk Myelofibrosis Transplant Scoring System score

Additionally, the authors noted the following:

• All allogeneic HSCT candidates “with splenomegaly greater than 5 cm below the left costal margin or splenomegaly-related symptoms” should receive a spleen-directed treatment, ideally a Janus kinase inhibitor.
• Reduced intensity conditioning and myeloablative conditioning regimens are both valid options prior to transplant.
• Regular monitoring for driver mutation after transplant is advised to detect and treat early relapse with donor lymphocyte infusion.
• Human leukocyte antigen-matched sibling donors remain the preferred donor source.

“In a disease where evidence-based guidance is scarce, these recommendations might help clinicians and patients in shared decision-making,” Dr. Kröger and collaborators summarized.

Reference

Kröger N, Bacigalupo A, Barbui T, et al. Indication and management of allogeneic haematopoietic stem-cell transplantation in myelofibrosis: updated recommendations by the EBMT/ELN International Working Group. Lancet Haematol. 2024;11(1):e62-e74. doi:10.1016/S2352-3026(23)00305-8