What is your approach to Myelofibrosis in Accelerated Phase (Blast percentage 10-19%) in a transplant-eligible patient?
I generally add HMA therapy to the JAK inhibitor and try to get them to transplant ASAP.
I agree with Dr. @Dr. First Last, 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%.
I agree with Drs. @Dr. First Last and @Dr. First Last, 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...
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.