Indication and management of allogeneic haematopoietic stem-cell transplantation in myelofibrosis: updated recommendations by the EBMT/ELN International Working Group
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Indication and management of allogeneic haematopoietic stem-cell transplantation in myelofibrosis: updated recommendations by the EBMT/ELN International Working Group. / Kröger, Nicolaus; Bacigalupo, Andrea; Barbui, Tiziano; Ditschkowski, Markus; Gagelmann, Nico; Griesshammer, Martin; Gupta, Vikas; Hamad, Nada; Harrison, Claire; Hernandez-Boluda, Juan Carlos; Koschmieder, Steffen; Jain, Tania; Mascarenhas, John; Mesa, Ruben; Popat, Uday R; Passamonti, Francesco; Polverelli, Nicola; Rambaldi, Alessandro; Robin, Marie; Salit, Rachel B; Scott, Bart L; Tamari, Roni; Tefferi, Ayalew; Vannucchi, Alessandro M; McLornan, Donal P; Barosi, Giovanni.
In: LANCET HAEMATOL, Vol. 11, No. 1, 01.2024, p. e62-e74.Research output: SCORING: Contribution to journal › SCORING: Review article › Research
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TY - JOUR
T1 - Indication and management of allogeneic haematopoietic stem-cell transplantation in myelofibrosis: updated recommendations by the EBMT/ELN International Working Group
AU - Kröger, Nicolaus
AU - Bacigalupo, Andrea
AU - Barbui, Tiziano
AU - Ditschkowski, Markus
AU - Gagelmann, Nico
AU - Griesshammer, Martin
AU - Gupta, Vikas
AU - Hamad, Nada
AU - Harrison, Claire
AU - Hernandez-Boluda, Juan Carlos
AU - Koschmieder, Steffen
AU - Jain, Tania
AU - Mascarenhas, John
AU - Mesa, Ruben
AU - Popat, Uday R
AU - Passamonti, Francesco
AU - Polverelli, Nicola
AU - Rambaldi, Alessandro
AU - Robin, Marie
AU - Salit, Rachel B
AU - Scott, Bart L
AU - Tamari, Roni
AU - Tefferi, Ayalew
AU - Vannucchi, Alessandro M
AU - McLornan, Donal P
AU - Barosi, Giovanni
N1 - Copyright © 2023 Elsevier Ltd. All rights reserved.
PY - 2024/1
Y1 - 2024/1
N2 - New options for medical therapy and risk scoring systems containing molecular data are leading to increased complexity in the management of patients with myelofibrosis. To inform patients' optimal care, we updated the 2015 guidelines on indications for and management of allogeneic haematopoietic stem-cell transplantation (HSCT) with the support of the European Society for Blood and Marrow Transplantation (EBMT) and European LeukemiaNet (ELN). New recommendations were produced using a consensus-building methodology after a comprehensive review of articles released from January, 2015 to December, 2022. Seven domains and 18 key questions were selected through a series of questionnaires using a Delphi process. Key recommendations in this update include: patients with primary myelofibrosis and an intermediate-2 or high-risk Dynamic International Prognostic Scoring System score, or a high-risk Mutation-Enhanced International Prognostic Score Systems (MIPSS70 or MIPSS70-plus) score, or a low-risk or intermediate-risk Myelofibrosis Transplant Scoring System score should be considered candidates for allogeneic HSCT. All patients who are candidates for allogeneic HSCT with splenomegaly greater than 5 cm below the left costal margin or splenomegaly-related symptoms should receive a spleen-directed treatment, ideally with a JAK-inhibitor; HLA-matched sibling donors remain the preferred donor source to date. Reduced intensity conditioning and myeloablative conditioning are both valid options for patients with myelofibrosis. Regular post-transplantation driver mutation monitoring is recommended to detect and treat early relapse with donor lymphocyte infusion. In a disease where evidence-based guidance is scarce, these recommendations might help clinicians and patients in shared decision making.
AB - New options for medical therapy and risk scoring systems containing molecular data are leading to increased complexity in the management of patients with myelofibrosis. To inform patients' optimal care, we updated the 2015 guidelines on indications for and management of allogeneic haematopoietic stem-cell transplantation (HSCT) with the support of the European Society for Blood and Marrow Transplantation (EBMT) and European LeukemiaNet (ELN). New recommendations were produced using a consensus-building methodology after a comprehensive review of articles released from January, 2015 to December, 2022. Seven domains and 18 key questions were selected through a series of questionnaires using a Delphi process. Key recommendations in this update include: patients with primary myelofibrosis and an intermediate-2 or high-risk Dynamic International Prognostic Scoring System score, or a high-risk Mutation-Enhanced International Prognostic Score Systems (MIPSS70 or MIPSS70-plus) score, or a low-risk or intermediate-risk Myelofibrosis Transplant Scoring System score should be considered candidates for allogeneic HSCT. All patients who are candidates for allogeneic HSCT with splenomegaly greater than 5 cm below the left costal margin or splenomegaly-related symptoms should receive a spleen-directed treatment, ideally with a JAK-inhibitor; HLA-matched sibling donors remain the preferred donor source to date. Reduced intensity conditioning and myeloablative conditioning are both valid options for patients with myelofibrosis. Regular post-transplantation driver mutation monitoring is recommended to detect and treat early relapse with donor lymphocyte infusion. In a disease where evidence-based guidance is scarce, these recommendations might help clinicians and patients in shared decision making.
U2 - 10.1016/S2352-3026(23)00305-8
DO - 10.1016/S2352-3026(23)00305-8
M3 - SCORING: Review article
C2 - 38061384
VL - 11
SP - e62-e74
JO - LANCET HAEMATOL
JF - LANCET HAEMATOL
SN - 2352-3026
IS - 1
ER -
