Despite the introduction of JAK inhibitors, allogeneic hematopoietic cell transplant remains the only potentially curative treatment for patients with myelofibrosis but has considerable treatment‐related complications. Whether the incorporation of JAK inhibition into the transplant algorithm leads to improved outcomes is still unclear. Here, we analyzed different transplant platforms in myelofibrosis patients undergoing a first transplant, comparing immune profiles and outcomes of (1) 33 patients continuing JAK inhibition at start of conditioning until stable engraftment (PERI‐group), (2) 38 patients receiving JAK inhibition prior to transplant until start of conditioning (PRE‐group), and (3) 38 patients that had never received JAK inhibition (NON‐group). Patients in the PERI‐group showed significantly higher early B‐cell recovery as well as significantly increased late recovery of gamma‐delta T cells and NK cells. We observed excellent neutrophil and platelet engraftment (100% for both) in the PERI‐group and no hematotoxic effects or increased rates of infections following peri‐transplant JAK inhibition. Cumulative incidence of acute graft‐versus‐host disease (GvHD) grade II‐IV at day 100 after transplant was 15% in the PERI‐group versus 29% in the PRE‐group versus 34% in the NON‐group. Cumulative incidence of relapse at 1 year after transplant was 9% in the PERI‐group compared with 16% in the PRE‐group and 18% in the NON‐group. In conclusion, peri‐transplant JAK inhibition was feasible with promising engraftment and acute GvHD rates, though deserves further investigation.

中文翻译：

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围移植期 JAK 抑制治疗骨髓纤维化的临床和免疫效应


尽管引入了 JAK 抑制剂，但同种异体造血细胞移植仍然是骨髓纤维化患者唯一可能治愈的治疗方法，但具有相当大的治疗相关并发症。将 JAK 抑制纳入移植流程是否会导致结局改善尚不清楚。在这里，我们分析了接受首次移植的骨髓纤维化患者的不同移植平台，比较了 （1） 33 例在预处理开始时继续 JAK 抑制直至稳定植入的患者（PERI 组），（2） 38 例在移植前接受 JAK 抑制直至预处理开始的患者（PRE 组），以及 （3） 38 名从未接受过 JAK 抑制的患者（非组）。PERI 组患者的早期 B 细胞恢复率显著升高，γ-δ T 细胞和 NK 细胞的晚期恢复率显著增加。我们在 PERI 组中观察到出色的中性粒细胞和血小板植入 （两者均为 100%），并且在围移植期 JAK 抑制后没有血液毒性作用或感染率增加。移植后第 100 天急性移植物抗宿主病 （GvHD） II-IV 级的累积发生率为 PERI 组 15%，PRE 组为 29%，非组为 34%。移植后 1 年的累积复发率在 PERI 组中为 9%，而 PRE 组为 16%，非组为 18%。总之，围移植期 JAK 抑制是可行的，植入率和急性 GvHD 率有希望，但值得进一步研究。