Role of allo-HCT in “nonclassical” MPNs and MDS/MPNs: recommendations from the PH&G Committee and the CMWP of the EBMT
Abstract
Abstract “Nonclassical” myeloproliferative neoplasms (MPNs) and myelodysplastic/myeloproliferative neoplasms (MDS/MPNs) represent a heterogeneous group of malignancies characterized by a wide range of clinical manifestations. Unlike classical MPNs, there is no standardized management approach for these conditions, particularly concerning the indications for and management of allogeneic hematopoietic cell transplantation. To address this gap, the European Society for Blood and Marrow Transplantation (EBMT) Practice Harmonization and Guidelines (PH&G) Committee and the Chronic Malignancies Working Party (CMWP) have collaborated to develop shared guidelines aimed at optimizing the selection and management of patients with these rare forms of neoplasms. A comprehensive review of the literature from the publication of the revised fourth edition of the (2016) World Health Organization classification onward was conducted. A multidisciplinary group of experts in the field convened to produce this document, which was developed through multiple rounds of draft circulation. Key recommendations include the early identification of potential transplant candidates, particularly in cases of chronic neutrophilic leukemia, chronic eosinophilic leukemia (CEL)/CEL, not otherwise specified (CEL-NOS), myeloid/lymphoid neoplasm with eosinophilia and tyrosine kinase gene fusions with FGFR1, JAK2, ABL1, and FLT3 rearrangements, MDS/MPN with neutrophilia/atypical chronic myeloid leukemia, and MDS/MPN, NOS. For patients with MPN, NOS/MPN unclassifiable, standard recommendations for myelofibrosis should be applied. Similarly, in MDS/MPN with thrombocytosis, transplantation is recommended on the basis of established MDS guidelines. Given the current lack of robust evidence, this document will serve as a valuable resource to guide future research activities, providing a framework for addressing critical unanswered questions and advancing the field.
Article Details
Authors (48)
Nicola Polverelli
1Unit of Bone Marrow Transplantation and Cellular Therapies - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Juan Carlos Hernández-Boluda
8Hospital Clínico Universitario, Instituto de Investigación Sanitaria, University of Valencia, Valencia, Spain
Francesco Onida
22ASST Fatebenefratelli-Sacco, University Milan, Milan, Italy
Carmelo Gurnari
1Translational Hematology & Oncology Research, Cleveland Clinic, Cleveland, OH
Kavita Raj
20University College London Hospitals NHS Trust, London, United Kingdom
Tomasz Czerw
24Hematology Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice, Poland
Michelle Kenyon
1King's College Hospital NHS Foundation Trust, Haematology, London, United Kingdom
Marie Robin
9Hôpital Saint Louis (APHP), Service d'hématologie, Paris, France
Katja Sockel
4Department of Internal Medicine I, University Hospital Dresden, Dresden University of Technology, Dresden, Germany
Annalisa Ruggeri
8San Raffaele Scientific Institute, Milan, Italy
Isabel Sanchez-Ortega
6EBMT Executive Office, Barcelona, Spain
Daniel A. Arber
The University of Chicago Medicine
Luca Arcaini
Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Fernando Barroso Duarte
16Hospital Universitário Walter Cantídio, Fortaleza, Brazil
Giorgia Battipaglia
5Department of Clinical Medicine and Surgery, University Federico II, Hematology, Naples, Italy
Yves Chalandon
25Swiss Group for Clinical Cancer Research, Bern, Switzerland
Fabio Ciceri
Vita-Salute San Raffaele University, Milan
Nicholas C. P. Cross
Joanna Drozd-Sokolowska
1Medical University of Warsaw, Department of Hematology, Transplantation and Internal Medicine, Warsaw, Poland
Vaneuza Funke
7Hospital das Clínicas - Universidade Federal do Paraná, Curitiba, Brazil
Nico Gagelmann
From the Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Naseema Gangat
4Mayo Clinic, Scottsdale, United States
Jason Gotlib
15Division of Hematology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA
Paola Guglielmelli
3Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
Claire Harrison
11Department of Haematology, Guy’s and St Thomas’ National Health Service Foundation Trust, London, United Kingdom
Gabriela Hobbs
Massachusetts General Hospital, Boston, Massachusetts, United States
Tania Jain
1Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
Joseph D. Khoury
3Department of Pathology, Microbiology, and Immunology, University of Nebraska Medical Center, Omaha, NE
Jean Jacques Kiladjian
8Department of Haematology, King's College Hospital, London, United Kingdom
Nicolaus Kröger
From the Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Luca Malcovati
Massimo Martino
12Stem Cell Transplant and Cellular Therapies Unit, Great Metropolitan Hospital “Bianchi-Melacrino-Morelli”, Reggio Calabria, Italy
Ruben Mesa
8Atrium Health Wake Forest, Winston, United States
Attilio Orazi
9Texas Tech University Health Sciences Center, El Paso, TX, United States
Eric Padron
Moffitt Cancer Cancer and Research Institute, Tampa, Florida, United States
Francesca Palandri
2Seragnoli Hematology Institute, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Francesco Passamonti
University of Milan, Milan
Mrinal M. Patnaik
Division of Hematology, Department of Internal Medicine, Mayo Clinic
Naveen Pemmaraju
The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
Deepti H. Radia
26Department of Haematology, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
Andreas Reiter
Domenico Russo
Institute of Endotypes in Oncology, Metabolism and Immunology “G. Salvatore,” National Research Council of Italy
Christof Scheid
12Hospital Barmherzige Brueder Regensburg, Clinic for Oncology and Hematology, Regensburg, Germany
Ayalew Tefferi
4Mayo Clinic, Scottsdale, United States
Alessandro M. Vannucchi
3Center for Research and Innovation of Myeloproliferative Neoplasms, AOU Careggi, University of Florence, Florence, Italy
Daniel H. Wiseman
7Cancer Research Division, Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, Spain
Ibrahim Yakoub-Agha
9CHU de Lille, Univ Lille, INSERM U1286, Infinite, 59000 Lille, Lille, France
Donal P. McLornan
14Department of Haematology and Stem Cell Transplantation, University College London Hospitals NHS Foundation Trust, London, United Kingdom