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What is your approach to Myelofibrosis in Accelerated Phase (Blast percentage 10-19%) in a transplant-eligible patient?
Do you consider "bridging" therapy prior to transplant, and if so, what are your thoughts on the intensity of the chemotherapy?
Answer from: Medical Oncologist at Community Practice
I generally add HMA therapy to the JAK inhibitor and try to get them to transplant ASAP.
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Answer from: at Academic Institution
I agree with Dr. @Bose, I generally treat with HMA and get to transplant if possible. Although there is data suggesting it may not be necessary, I usually prefer to get the blasts to <10%.
Answer from: Medical Oncologist at Academic Institution
I agree with Drs. @Bose and @Palmer, I like to add HMA as a bridge to transplant. If they are on a JAK inhibitor, I may keep it on per the MPD-RC HMA/Rux study. However, for patients who aren't on high doses, I have given HMA/Venetoclax in those that can tolerate it. The key, as Dr. Bose said, is to...
Answer from: at Academic Institution
Agree with what's been said above! There are recently published data from our group that HMA-based therapies have similar survival to HMA + VEN based therapies in accelerated/blast-phase MPNs; with that in mind, I tend towards an HMA +/- JAK inhibitor approach for those in the accelerated phase.Pate...