Primary myelofibrosis has progressed to accelerated phase — defined as a persistent increase to 10–19% blasts in blood or marrow — or to blast phase, with a persistent increase to 20% or more blasts. The patient is considered transplant eligible. This presentation poses significant management challenges, particularly in the older population.
Remission-induction intensive chemotherapy or a hypomethylating agent (with or without ruxolitinib), given with the intent to reduce blasts prior to transplant, did not achieve the target: reduction of blasts in blood or marrow. The protocol below addresses the next clinical step in this situation.
For transplant-eligible patients in this setting, management is centred on a transplant-based strategy that remains the only potentially curative option. Early specialist referral is a key early step in the pathway. The full sequencing and eligibility criteria are in the complete protocol.
Accelerated phase (AP; persistent increase to 10%–19% blasts in blood or marrow) and blast phase (BP; persistent increase to ≥20% blasts in blood or marrow) MF presents many challenges, particularly in the older population.
Considered transplant eligible.
The only curative option remains allo-HSCT, applicable to only a small number of patients.
If transplant eligible, HLA typing and early referral to a stem cell transplant centre are required (Grade 1B).
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