EBMT 2026 | Insights into the updated remission criteria following alloSCT for myelofibrosis

The talk I gave on remission definition regarding myelofibrosis stemmed from a group that I organized in 2024 of myelofibrosis experts to try to redefine remission following stem cell transplant for myelofibrosis. Previously, we were using the IWG-MRT criteria that were developed in 2013. And I was approached by the CIBMTR because they felt that we weren’t accurately capturing remission following myelofibrosis, and that was making not only manuscripts, but CIBMTR reporting of remission inconsistent. And they requested that we come up with a definition that was more timely and more accurately captured the definition of remission, both for reporting to the CIBMTR, the EBMT database, as well as in manuscripts. 

And what I’ve found since then is that our new definition, which is really centered around molecular remission, so driver mutation remission and somatic mutation remission for myelofibrosis is much more satisfying for patients. So now that we have patients who are with full donor chimerism and molecular remission, but still have persistent fibrosis and splenomegaly and sometimes even low blood counts who were previously very frustrated that they did this transplant for nought are now feeling much more satisfied with the fact that their molecular mutations have resolved and we’re calling this remission. 

So our next steps really are to validate this definition. I think the complications that I talked about in the talk are that there’s very different testing being done at centers in terms of sensitivity of this molecular testing. So hopefully in the future, near future, we’ll be able to harmonize the mutation testing and be able to even further refine this definition. 

So if the patients are in molecular remission, we don’t necessarily feel like they need any further intervention at that point. And we are recommending, as several people asked in questions in the panel afterwards, serial mutation testing over time, at least for five years, but indefinitely, if we can get that covered by insurance. If they do develop a molecular relapse early on, we then could intervene with a donor lymphocyte infusion. We know that patients who have a molecular relapse respond better to intervention than patients who have a hematologic relapse, and so that would inform that intervention. But now patients who have persistent low counts or persistent splenomegaly would just continue on to be observed and wouldn’t need any further treatment.

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