MPN Workshop of the Carolinas 2025 | Optimizing the timing of alloSCT in MPN-AP/BP: the importance of disease control

We know that allogeneic transplant is really the only curative modality for patients with accelerated/blast-phase disease. We also know that some degree of disease control is essential for patients to have durable outcomes post-transplant. In the accelerated phase, there are data to support taking patients directly to transplant without blast reduction. So a study led by our European colleagues looked at these patients specifically and found a three-year overall survival of about 65% for patients in accelerated phase that go directly to transplant without blast reduction. 

Now, in blast phase greater than or equal to 20% blasts, in general, our paradigm is to try and reduce the blast percentage at least down below 10% and perhaps even down below 5%. 

The major issue has been is when we look at the outcomes of patients post-transplant, it does not seem that blast reduction is a great proxy for who has a cure with transplant and who relapses post-transplant. So in my mind, when thinking about transplant eligibility, of course, age, fitness, other medical comorbidities, just thinking about is someone an appropriate candidate for transplant in general? And then when thinking about disease-specific factors, in my mind, the big thing is trying to have the disease more approximate a chronic phase of disease. So ideally trying to get that blast percentage down below 10%. We don’t know if trying to really strive for less than 5% is all that beneficial. We do know that if we’re taking patients to transplant with 20, 25, 30% blasts, it’s very, very likely that they’re going to have an early relapse post-transplant.

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