Dr Patel on How the Timing of ASCT Affects Post-Transplant Complications in Myelofibrosis

Sagar Patel, MD, director of Communications and Media Relationships for the Division of Hematology, University of Utah, Huntsman Cancer Institute, discusses how the timing of autologous stem cell transplant (ASCT) can affect outcomes in those with myelofibrosis, including the risk of patients developing post-transplant complications.

ASCT is often an effective, potentially curative approach for the treatment of patients with myelofibrosis. However, many patients will experience post-ASCT complications such as splenomegaly, cytopenia, infection, and a higher risk of leukemic transformation. These adverse effects (AEs) are all associated with higher mortality.

The optimal timing for ASCT has been more clearly elucidated in tumor types such as acute myeloid leukemia (AML) or high-risk myelodysplastic syndromes (MDS), according to Patel. For example, patients with AML or high-risk MDS can experience disease recurrence if there is a substantial delay in ASCT administration, Patel notes. Accordingly, these patients should undergo ASCT as soon as they have achieved complete remission, he says.

However, the identification of patients who would benefit from early vs delayed transplantation strategies is not well understood in myeloproliferative neoplasms like myelofibrosis, Patel adds. Moreover, the timing of ASCT in myelofibrosis often depends on the availability of potential donors, as well as the patient’s response to first- or second-line therapeutics, Patel states. These agents are often utilized to potentially reduce future post-ASCT complications and improve other AEs, he explains.

The JAK inhibitor ruxolitinib (Jakafi) is one such agent and has been increasingly utilized in this space. Although ruxolitinib is known to improve spleen-related symptoms and quality of life in patients with myelofibrosis when administered perioperatively, it is not curative. Accordingly, patients who initially receive these treatments do not typically experience complete remission, and still require subsequent ASCT, Patel concludes.