Factors influencing the choice between HCT vs nontransplant therapies
| Factors . | . |
|---|---|
| Characteristics Severe thrombocytopenia (<50 × 109/L) | Reason for poorer outcomes with nontransplant therapy No data on the use of ruxolitinib in this subgroup |
| Challenging to safely deliver adequate doses of ruxolitinib in severely thrombocytopenic patients | |
| Heavily transfusion-dependent anemia | Anemia is a major toxicity of JAK inhibitor therapy, and may worsen with treatment1,2 |
| ≥3 mutations | Shorter time to treatment failure with ruxolitinib6 |
| Increased risk of LT9,10 | |
| High-risk cytogenetics | Increased risk of LT7,8 |
| Impact of high-risk cytogenetics on ruxolitinib-treated patients not well studied | |
| Increasing blasts in peripheral blood | Increasing blasts is a risk factor for LT7 |
| Characteristics | Reason for poorer outcomes with HCT |
| Poor performance status | Increased NRM and decreased survival14 |
| Comorbidities | Severe comorbidities result in higher NRM15,18 |
| Advanced age | Very advanced age adversely impacts HCT outcomes11,19 |
| Response to JAK inhibitor therapy is not impacted by advanced age13 | |
| Mismatched donor | Mortality almost double compared with MSD/well-matched URD12,17 |
| Severe portal hypertension | Possible increase in regimen-related hepatotoxicity16 |
| Factors . | . |
|---|---|
| Characteristics Severe thrombocytopenia (<50 × 109/L) | Reason for poorer outcomes with nontransplant therapy No data on the use of ruxolitinib in this subgroup |
| Challenging to safely deliver adequate doses of ruxolitinib in severely thrombocytopenic patients | |
| Heavily transfusion-dependent anemia | Anemia is a major toxicity of JAK inhibitor therapy, and may worsen with treatment1,2 |
| ≥3 mutations | Shorter time to treatment failure with ruxolitinib6 |
| Increased risk of LT9,10 | |
| High-risk cytogenetics | Increased risk of LT7,8 |
| Impact of high-risk cytogenetics on ruxolitinib-treated patients not well studied | |
| Increasing blasts in peripheral blood | Increasing blasts is a risk factor for LT7 |
| Characteristics | Reason for poorer outcomes with HCT |
| Poor performance status | Increased NRM and decreased survival14 |
| Comorbidities | Severe comorbidities result in higher NRM15,18 |
| Advanced age | Very advanced age adversely impacts HCT outcomes11,19 |
| Response to JAK inhibitor therapy is not impacted by advanced age13 | |
| Mismatched donor | Mortality almost double compared with MSD/well-matched URD12,17 |
| Severe portal hypertension | Possible increase in regimen-related hepatotoxicity16 |
MSD, HLA-matched sibling donor; NRM, nonrelapse mortality.