A European survey on allogeneic haematopoietic cell transplantation for myelofibrosis on behalf of the Chronic Malignancies Working Party of the EBMT: focus on ‘real world’ experience of JAK inhibitors, splenomegaly management and novel agents in the

Allogeneic haematopoietic cell transplantation (allo-HCT) remains the only potentially curative option for patients with myelofibrosis (MF), yet the integration of JAK inhibitors (JAKi) and novel agents into transplant pathways has created increasing complexity. To capture current real-world practice, the EBMT Chronic Malignancies Working Party conducted a survey of 19 high-volume European centres performing MF allo-HCT. Most centres (68%) routinely initiated JAKi, primarily ruxolitinib, in transplant-eligible patients prior to conditioning, with goals of splenomegaly reduction and symptom control. Management of ruxolitinib intolerance or resistance was heterogeneous, with strategies including switching to alternative JAKi, proceeding directly to allo-HCT, or enroling in clinical trials. Peri-transplant approaches also varied: over half of centres continued ruxolitinib throughout conditioning, while others employed tapering or abrupt discontinuation. Experience with newer JAKi and investigational therapies was limited. Post-transplant, most centres did not routinely reintroduce JAKi, although some used them for relapse or GVHD mitigation. Notably, many centres reported transplant delays due to prolonged medical therapy, with adverse consequences including disease progression. These findings highlight significant heterogeneity in practice, which is likely to increase as more novel agents are integrated in treatment algorithms. Harmonised, multidisciplinary guidelines to optimise timing and outcomes for MF patients eligible for allo-HCT are needed.

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Publication Details

Journal
Bone Marrow Transplantation
Published
2025-12-24
DOI
https://doi.org/10.1038/s41409-025-02780-2
Primary Topic
Myeloproliferative Neoplasms: Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
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article

A European survey on allogeneic haematopoietic cell transplantation for myelofibrosis on behalf of the Chronic Malignancies Working Party of the EBMT: focus on ‘real world’ experience of JAK inhibitors, splenomegaly management and novel agents in the

M. de Witte, Tomasz Czerw, Hernandez-Boluda Juan Carlos, Donal P. McLornan et al.
Bone Marrow Transplantation
Myeloproliferative Neoplasms: Diagnosis and Treatment
article

A European survey on allogeneic haematopoietic cell transplantation for myelofibrosis on behalf of the Chronic Malignancies Working Party of the EBMT: focus on ‘real world’ experience of JAK inhibitors, splenomegaly management and novel agents in the

M. de Witte, Tomasz Czerw, Hernandez-Boluda Juan Carlos, Donal P. McLornan, M. Thérèse Rubio, Maria Chiara Finazzi, G. Battipaglia, Micha Srour, Cristina Castilla‐Llorente, Erfan NUR, Joanna Ewa Drozd-Sokolowska, Daniele Avenoso, Katja Sockel, Alexandros Rampotas, M. Robin, Patryk Sobieralski, José María Aspa-Cilleruelo, Elisa Sala, Linda Köster, Ahmad Alabdulkarim, Nicola Polverelli, Patrice Chevallier, Mareike Verbeek, Thomas Schroeder, Urpu Salmenniemi, Jakob Passweg, Anders Eivind Myhre, Kavita Raj, Patrizia Chiusolo
article en

Abstract

Allogeneic haematopoietic cell transplantation (allo-HCT) remains the only potentially curative option for patients with myelofibrosis (MF), yet the integration of JAK inhibitors (JAKi) and novel agents into transplant pathways has created increasing complexity. To capture current real-world practice, the EBMT Chronic Malignancies Working Party conducted a survey of 19 high-volume European centres performing MF allo-HCT. Most centres (68%) routinely initiated JAKi, primarily ruxolitinib, in transplant-eligible patients prior to conditioning, with goals of splenomegaly reduction and symptom control. Management of ruxolitinib intolerance or resistance was heterogeneous, with strategies including switching to alternative JAKi, proceeding directly to allo-HCT, or enroling in clinical trials. Peri-transplant approaches also varied: over half of centres continued ruxolitinib throughout conditioning, while others employed tapering or abrupt discontinuation. Experience with newer JAKi and investigational therapies was limited. Post-transplant, most centres did not routinely reintroduce JAKi, although some used them for relapse or GVHD mitigation. Notably, many centres reported transplant delays due to prolonged medical therapy, with adverse consequences including disease progression. These findings highlight significant heterogeneity in practice, which is likely to increase as more novel agents are integrated in treatment algorithms. Harmonised, multidisciplinary guidelines to optimise timing and outcomes for MF patients eligible for allo-HCT are needed.

Bone Marrow TransplantationVol. 61(3)
Oslo University Hospital (NO), Utrecht University (NL), Université Paris Cité (FR), Medical University of Warsaw (PL), Helsinki University Hospital (FI), Cancer Research UK (GB), Institut Gustave Roussy (FR), University Hospital of Basel (CH), Agostino Gemelli University Polyclinic (IT), University Medical Center Utrecht (NL), Centre Hospitalier Universitaire de Lille (FR), Hospital Clínico Universitario de Valencia (ES), Assistance Publique – Hôpitaux de Paris (FR), European Society for Blood and Marrow Transplantation (NL), Centre Hospitalier Régional et Universitaire de Nancy (FR), Sheffield Teaching Hospitals NHS Foundation Trust (GB), Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT), Ospedale Papa Giovanni XXIII (IT), Essen University Hospital (DE), University Clinical Centre (PL), Hôpital Saint-Louis (FR), The London College (GB), CRUK Lung Cancer Centre of Excellence (GB), The Maria Sklodowska-Curie National Research Institute of Oncology (PL), Policlinico San Matteo Fondazione (IT), Amsterdam University Medical Centers (NL), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Centre Nantais de Sociologie (FR), University Hospital Ulm (DE), University Hospital Carl Gustav Carus (DE), University College London (GB), University of Naples Federico II (IT), Gdańsk Medical University (PL), University of Brescia (IT), University of Amsterdam (NL)
Openalex Percentile: Top 26%
Myeloproliferative Neoplasms: Diagnosis and Treatment
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