An overview of strategies for managing patients with myelofibrosis (MF) who may be candidates for allogeneic stem cell transplantation (allo-HCT) was presented by Nicola Polverelli, MD, PhD, from the University of Brescia, Italy, and colleagues. Their report was published in the journal Cells.

“This critical review highlights the complexity and the importance of pretransplant management of MF,” stated Dr Polverelli and colleagues. Allo-HCT is currently the only curative option for patients with MF, the researchers explained. But traditionally, allo-HCT has been restricted from most patients with MF. However, recent changes to the treatment landscape have made allo-HCT more feasible and safer for more patients.

When determining whether a patient with MF is a candidate for allo-HCT, prognostic scoring systems may not all be appropriate for all subtypes of MF, or in the setting of various disease-related mutations. For this reason, the researchers recommend following institutional policies for the use of prognostic indices in evaluating a patient’s risk status.

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Regarding patient eligibility for allo-HCT, Dr Polverelli and colleagues note that although many eligibility tools exist, not all have been tested in patients with MF. However, the Myelofibrosis-specific Transplant Scoring System is an approach that incorporates key factors to aid in the determination of patient eligibility for allo-HCT.

Regarding donor choice, the researchers indicated that sibling donors and high stem cell doses are preferred options for patients with MF. Matched-unrelated or haploidentical donors, they explained, may be suitable alternatives if preferred options are unavailable. Other donor characteristics, such as donor age and gender, female parity, AB0 compatibility, and cytomegalovirus serostatus combination are also important to consider.

Evidence from prospective trials is limited on myeloablative vs reduced-intensity conditioning regimens for patients with MF. Dr Polverelli and colleagues indicated that current data support the use of European Society for Blood and Marrow Transplantation/European LeukemiaNet consensus guidelines in determining the conditioning approach.

For pretransplant management of patients with MF, the researchers considered splenomegaly management to be especially important, with approaches including medical options, splenomegaly, and splenic irradiation, depending on circumstances. Beyond splenomegaly, control of cytopenias is also important, with many medical options available to address these.

Dr Polverelli and colleagues also discussed the importance of timing with allo-HCT. “Whether to proceed to transplant early or after treatment failure is a controversial area,” they explained. However, they note evidence supporting the use of allo-HCT prior to disease progression and indicated a preference for proceeding to transplant as soon as possible.

“Many small details can make a big difference in MF transplant outcome,” Dr Polverelli and colleagues stated. They concluded that a strict collaboration between physicians focusing on MF and allo-HCT is necessary.


Polverelli N, Farina M, D’Adda M, et al. How we manage myelofibrosis candidates for allogeneic stem cell transplantation. Cells. 2022;11(3):553. doi:10.3390/cells11030553