Peritransplantation Use of Ruxolitinib in Myelofibrosis

The application of JAK inhibitors in the peri-transplantation period of hematopoietic stem cell transplantation for myelofibrosis

“…Ruxolitinib (RUX) does not cure myelofibrosis or reduce the risk of acute leukemic transformation, some patients even acquire new mutations to evolve clonally, so the only treatment with curative potential remains allo-HSCT [5,6,24]. MF patients undergoing allo-HSCT have a high morbidity and mortality from transplantation-related complications, especially graft failure and GVHD.…”

“…Therefore, many centers have chosen to reduce or discontinue RUX prior to transplantation. RUX discontinuation may be followed by ruxolitinib discontinuation/withdrawal syndrome (RDS/RWS) [5,34]due to an acute rebound of cytokine storm, which is characterized by rapid disease progression, worsening cytopenia, rapid increase in splenomegaly, and even hemodynamic instability, respiratory distress, shock, and possible prospective study by Robin [42,43] et al, a total of 2 events of febrile cardiogenic shock and 1 event of tumor lysis syndrome (TLS) with acute renal failure occurred in patients (n = 10) for whom ruxolitinib was tapered over 15 days. In the other group of patients (n = 42), RUX was abruptly discontinued before conditioning, and only 1 developed cardiogenic shock.…”

“…But ruxolitinib (RUX) does not cure myelofibrosis or reduce the risk of acute leukemic transformation, and patients may even show clonal evolution due to the acquisition of new mutations. Therefore, the only treatment with curative potential remains allogeneic hematopoietic stem cell transplantation (allo-HSCT) [3,5,6]. MF patients undergoing allo-HSCT have a higher incidence of transplantation-related complications and mortality, especially implantation failure and graft-versus-host disease (GVHD).…”