When JAK Inhibitor Therapy Falls Short in Intermediate-2 or High-Risk Myelofibrosis (Age ≤70, Transplant Eligible)
In patients with intermediate-2 or high-risk primary myelofibrosis — scored by IPSS, DIPSS, or DIPSS+ — who are aged 70 years or younger and eligible for transplantation, initial management targets spleen and symptom reduction as a bridge toward definitive therapy. When that first-line strategy does not reach its goals, a structured next-line protocol applies.
Patient profile
Intermediate-2 or high-risk primary myelofibrosis by IPSS, DIPSS, or DIPSS+; age ≤70 years; considered a potential candidate for allogeneic haemopoietic stem cell transplantation.
Prior line — failure condition that triggers this protocol
The preceding treatment line used a JAK inhibitor (ruxolitinib) to maximise spleen and symptom response prior to transplant. This protocol is reached when that approach did not achieve its primary target: reduction of palpable splenomegaly to less than 5 cm.
References
Intermediate 2
Transplant Eligible
All patients with intermediate-2 or high-risk disease according to IPSS, DIPSS or DIPSS+, and age ≤70 years, should be considered potential candidates for allo-HSCT.
Allogeneic Stem Cell Transplant, ideally at time of best response
Allo-HSCT remains the only curative option for suitable candidates with MF.