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To best prepare a patient for transplant, we need a healthy amount of bone marrow preserves. They are essential to transplant eligibility. To protect the bone marrow, then, we need to control the disease as best as possible.
If you want to cure people, then the only way is to go to hematopoietic stem cell transplant. So, we always tell the patients that this is the ultimate goal. If your life expectancy, looking at different prognostic scoring systems, is judged to be less than five years, you should consider transplant. The right JAK inhibitors can help prepare a patient and get them in the right condition for transplant.
To best prepare a patient for transplant, we need to control their disease as best as possible. So JAK inhibitors have been around for quite some time, and we would give JAK inhibitors a few months, decrease the spleen, decrease the liver, improve the quality of life, and then say, “Now you are in the best possible shape, let’s do the transplant now, because I’m not sure how long this is going to last.”
But if a patient has descending blood counts, you need to be careful with some JAK inhibitors because they can cause thrombocytopenia or anemia, which can weaken the patient too much for a transplant. You want to keep blood counts as steady as you can, even improve their counts if possible. The goal is to have stable blood cell counts, improve the spleen, decrease the inflammation, improve their condition, and then they do the transplant.
