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JAKi throughout HCT reduces rates of aGvHD
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Allo-HCT remains the only potentially curative treatment option for MF, but is associated with considerable treatment-related complications.1 Studies have demonstrated benefits of pre-transplant JAKi treatment; and pre-transplant JAKi cessation can lead to withdrawal syndrome, accelerated splenomegaly, worsening of cytopenias, and other adverse outcomes. Therefore, there is a clinical rationale for using JAKis throughout the transplantation procedure to minimize risks and potentially maintain clinical responses. The impact of incorporating JAKis into the transplant algorithm on outcomes in MF remains unclear.1 Rathje et al.1 conducted a clinical and immunological study of patients with MF (N = 109) receiving JAKi throughout their HCT procedure (PERI-group; n = 33), comparing outcomes with patients who had never received JAKis (NON-group; n = 38) and those who ceased JAKi pre-transplant (PRE-group; n = 38). Their findings were published in the American Journal of Hematology.1 |
| Key learnings |
| Patients in the PERI-group achieved 100% neutrophil and platelet engraftment rates, significantly higher early B cell recovery, and significantly increased late recovery of γδ T cells and NK cells compared to patients in the NON- and PRE-groups. |
| The cumulative incidence of Grade II–IV aGvHD at Day 100 post transplantation was 15% in the PERI-group vs 34% in the NON-group and 29% in the PRE-group. OS estimates at 1 year were 97% for the PERI-group vs 84% for the NON-group and 82% for the PRE-group. |
| No hematotoxic effects or increased rates of infection were observed following peri-transplant JAKi treatment. The cumulative incidence of relapse at 1 year after transplant was 9% in the PERI-group vs 18% in the NON-group and 16% in the PRE-group. |
| These findings demonstrate the efficacy and safety of peri-transplant JAK inhibition, with promising engraftment and aGvHD rates; warranting further investigation to determine whether peri-transplant JAK inhibition should become the SoC for patients with MF. |
Abbreviations: aGvHD, acute graft-versus-host disease; allo-HCT, allogeneic hematopoietic cell transplant; JAK, Janus kinase; JAKi, JAK inhibitor; MF, myelofibrosis; NK, natural killer; SoC, standard of care.
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