Myelofibrosis-When Do We Select Transplantation or Non-transplantation Therapeutic Options?

Janus kinase 1/2 (JAK1/2) inhibitor therapy is effective in alleviating myelofibrosis (MF)-related symptoms. However, at present, the only curative therapy for MF patients is hematopoietic cell transplantation (HCT). The decision of whether to proceed with HCT, which carries significant risks, or continue with JAK inhibitor therapy is a complicated one. Nevertheless, careful assessment of patient, disease, and transplant-related factors can guide this decision on a case-by-case basis. Difficult questions arise in the decision-making process such as age limits, whether lower-risk patients are suitable candidates, and HCT in patients responding well to JAK inhibitor therapy. The optimal timing of transplant is a major dilemma in the management of MF patients who are responding to or are stable on JAK inhibitor therapy. In this paper, we provide our perspective on selection of transplant versus non-transplant therapies in the management of MF.