How we manage JAK inhibition in allogeneic transplantation for myelofibrosis

TY - JOUR

T1 - How we manage JAK inhibition in allogeneic transplantation for myelofibrosis

AU - Ballinger, Tarah J

AU - Savani, Bipin N

AU - Gupta, Vikas

AU - Kröger, Nicolaus-Martin

AU - Mohty, Mohamad

N1 - This article is protected by copyright. All rights reserved.

PY - 2015/2

Y1 - 2015/2

N2 - Hematopoietic stem cell transplantation (HCT) is currently the only curative treatment for myelofibrosis (MF), but this option is complicated by high incidences of associated morbidity and mortality. Ruxolitinib, a Janus activated kinase (JAK) 1/2 inhibitor, has proven to be beneficial in reduction of splenomegaly, improvement of constitutional symptoms, and possibly in overall survival. However, use of JAK inhibitors in the peri-transplant period has been complicated by unpredictable response, return of MF symptoms or cytokine storm reaction upon discontinuation, and lack of long term response data. This review considers the current limited available data on JAK inhibitor use prior to HCT, including common side effects and possible impact of severe adverse events on discontinuation of the drug. We provide our experience and recommendations regarding use of JAK inhibition in patients undergoing HCT. Additional studies are needed to determine the optimal schedule of JAK inhibitors in the transplant protocols and their impact on engraftment, graft versus host disease, and survival. This article is protected by copyright. All rights reserved.

AB - Hematopoietic stem cell transplantation (HCT) is currently the only curative treatment for myelofibrosis (MF), but this option is complicated by high incidences of associated morbidity and mortality. Ruxolitinib, a Janus activated kinase (JAK) 1/2 inhibitor, has proven to be beneficial in reduction of splenomegaly, improvement of constitutional symptoms, and possibly in overall survival. However, use of JAK inhibitors in the peri-transplant period has been complicated by unpredictable response, return of MF symptoms or cytokine storm reaction upon discontinuation, and lack of long term response data. This review considers the current limited available data on JAK inhibitor use prior to HCT, including common side effects and possible impact of severe adverse events on discontinuation of the drug. We provide our experience and recommendations regarding use of JAK inhibition in patients undergoing HCT. Additional studies are needed to determine the optimal schedule of JAK inhibitors in the transplant protocols and their impact on engraftment, graft versus host disease, and survival. This article is protected by copyright. All rights reserved.

U2 - 10.1111/ejh.12455

DO - 10.1111/ejh.12455

M3 - SCORING: Journal article

C2 - 25256963

VL - 94

SP - 115

EP - 119

JO - EUR J HAEMATOL

JF - EUR J HAEMATOL

SN - 0902-4441

IS - 2

ER -