Transplantation algorithm for myelofibrosis in 2022 and beyond

Myelofibrosis (MF) is a chronic myeloproliferative neoplasm with a very heterogenous clinical course. Median survival of patients with overt MF is close to 6 years, but with great individual variability. Allogeneic hematopoietic cell transplantation (allo-HCT) constitutes the only curative treatment, yet the advanced age of MF patients, together with significant transplant-related mortality, limit the applicability of this procedure in clinical practice to less than 10% of patients. In this article, we review the current indications for allo-HCT in MF and factors that should be considered when selecting candidates for the procedure. To this end, we describe the prognostic tools that have been developed to predict survival in MF patients managed with conventional pharmacological therapies and allo-HCT. We then summarize the main results of allo-HCT, review practical aspects of the procedure, and discuss optimal timing, particularly in relation to JAK inhibitor treatment.