In transplant-eligible patients with primary myelofibrosis, a short course of bridge therapy is given first to optimise the patient's condition before proceeding. When that bridge therapy does not achieve the required clinical improvement, a defined next protocol applies.
The preceding step was a short course of ruxolitinib, fedratinib, or pacritinib (at maximum tolerated dose, together with anemia-oriented treatment) as bridge therapy before transplant.
The goal of that step was clinical improvement — specifically, reduction of splenomegaly and symptoms — prior to proceeding. When that improvement is not achieved, this protocol is the designated next step.
The approach at this stage centres on allogeneic stem cell transplantation. The complete protocol — including selection refinements, conditioning strategy, and perioperative management — is accessible via the link below.
DOI: 10.1182/blood.2022017423
SCT is the only curative option for patients with MF: 1 out of 2 can be cured at 5 years.
Donor available, and SCT-related survival higher than 5 years.
Physiological age, good PS, not-high CI.
MF-related life expectancy less than 5 years.
It is acceptable to select patients with an expected survival lower than 5 years (ie, intermediate-2 and high-risk DIPSS or MYSEC-PM/ high-risk MIPSS-70; Figure 1).
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