1. JAK2 INHIBITORS AND ALLOGRAFTING
Andrea Bacigalupo, Genova, Italy

2. Significant reduction of spleen size with ruxolitinib

3. Significant survival advantage for ruxolitinib

4. Thus spleen size = progression Reduction of spleen size = control of progression
Reduction of tumour masss?
survival advantage is superior with greater spleen size reduction

5. results of allogeneic hemopoietic stem cell transplants (HSCT) are dependent on disease phase
# DIPSS
# Spleen size, transfusion requirement

7. results of allogeneic hemopoietic stem cell transplants (HSCT) are dependent on disease phase
# DIPSS
# Spleen size, transfusion requirement

8. SPLEEN SIZE AND SURVIVAL in 70 allografted MF (GE SM)
Spleen <22 cm; n=29
68%
23%
Spleen >22 cm; n=31
P=0.0008

9. CD34 PB cell counts and SURVIVAL in 70 allografted MF (GE SM)
CD34 <8 /cmm n=13
66%
CD /cmm n=30
38%
24%
CD34 >486/cmm n=15
Days from transplant

10. Spleen size and CD34 cell count
CD34 cell counts

11. Patients with a large spleen have advanced disease
Survival after allogeneic transplant is worse in patients with a large spleen
Survival after allogeneic transplant is also worse in patients with high CD34 counts
High CD34 counts correlate with large spleen

12. JAK2 inhibitors can reduce spleen size
JAK2 inhibitors are good candidates for treatment BEFORE an allogeneic transplant
Also AFTER an allogeneic transplant

14. Death rate Low = 5% /year Int-1 = 6.7% /year Int-2 = 8.3% /year
Cervantes et al Blood 2009; 113: 2895: IPSS
Death rate
Low = 5% /year
Int-1 = % /year
Int-2 = % /year
High = % /year

16. Good outcome after SCT
Poor outcome after SCT

17. Reduction of tumour mass
Riulitinib
Improved outcome after SCT ??
Good outcome after SCT

18. Conclusion
SCT transplant outcome is dependent on disease phase
Ruxolitinib may improve SCT outcome for patients with advanced disease