Determining Transplantation Needs and Risk Factors in Myelofibrosis Care

In a conversation with CancerNetwork^®, Nicolaus Kröger, MD, spoke about a presentation he gave at the Seventh Annual Miami Cancer Institute Immunotherapies Summit for Hematologic Malignancies, which focused on appropriate circumstances for using transplantation for patients with myelofibrosis. He detailed life expectancy and risk factors among other characteristics clinicians should consider when weighing the potential benefits of transplantation for this population.

According to Kröger, patients with initially good risk factors may develop worse risks 2 to 3 years later down the line, which may necessitate monitoring them for possible transplantation. He described how HLA donor availability is another key factor to keep in mind, as transplantation using mismatched donors may yield worse outcomes.

Kröger is the medical director of the Department of Stem Cell Transplantation at the University Medical Center Hamburg-Eppendorf in Hamburg, Germany, as well as a professor of Medicine at the University of Hamburg.

Transcript:

If the patient has a life expectancy of less of 5 years, this can be an indication for transplantation, and the patient should be sent to a transplanter who should evaluate the eligibility for stem cell transplantation. But in reality, the story is more complicated because this is [unlike] other hematological diseases; it is a clonal evolution. Even patients who have a good risk factor today might have bad risk factors in 2 or 3 years, so those patients need to be followed. At the end, we have patients who need an immediate transplant, and patients should be followed and receive the transplant only if they are [experiencing progression].

What I also [showed] is that the indication, historically, is mainly based on disease-specific factors. If you have a bad disease, you should go for transplantation. However, in the transplant field, you also have risk factors, that means we should also consider transplant-specific risk factors. One example, for instance, in myelofibrosis, is the donor availability, or the HLA. If there is only a mismatched donor, then the outcome is much worse than if there are completely matched donors, which is different nowadays in comparison to acute myeloid leukemia, for instance. These are things that you have to take into this decision model, or decision-finding, together with the patients. You need to clear a good consultant to counsel the patient about the risk of the disease, but also the risk of the transplant, and then come up with a common decision to go immediately for transplant, later to transplant, or maybe [abstain from] transplant.

Reference

Kröger N. Myelofibrosis: who to transplant and who not to transplant? Presented at the Seventh Annual Miami Cancer Institute Immunotherapies Summit for Hematologic Malignancies; March 6-7, 2026. Miami, FL.