Which Prognostic Factors Guide HCT Eligibility for Patients with Myelofibrosis?

In this review, the authors outline the prognostic factors used to guide decision-making in patients with myelofibrosis (MF). Factors include the use of the Dynamic International Prognostic Scoring System (DIPSS) and the presence of driver mutations such as those in Janus kinase 2 (JAK2), myeloproliferative leukemia, and calreticulin receptor (CAL-R). They discuss how identified somatic mutations combined with the DIPSS allows providers to stratify the risk of disease progression, which ultimately affects the timing of treatment.

The authors discuss several treatment options that may provide symptom relief and improvement in survival, but they note that allogeneic hematopoietic cell transplantation (HCT) is the only potentially curative option. Current guidelines recommend HCT for eligible patients with intermediate-2 or high-risk disease.

Biological age and disease status should be considered equally important, according to the authors. Comorbidities can be assessed during the consultation, using the HCT comorbidity index tool, and functional status can be evaluated by the geriatric assessment tool.

With multiple treatment options available for patients with MF, the prognostic factors for HCT outcomes presented by the authors allow for decision-making “to select the ‘right patients’ at the ‘right time’ in their disease course to gain the most benefit from this valuable therapeutic option.”

Jain T, et al. Biol Blood Marrow Transplant