Mentioned 24× · first seen 28-apr-2026 · last seen 25-oct-2026

Pre-transplant bridging (ruxolitinib)

Current understanding

Use of ruxolitinib before transplant to reduce splenomegaly and improve performance status. Optimal timing/dose still debated.

Evidence log

2026-07-20 — Reduced Intensity Haploidentical Transplantation for the Treatment of Primary or Secondary Myelofibrosis: Phase II RIC haploidentical HCT trial in MF found that pre-transplant JAK inhibitor bridging produced universal engraftment (no graft failure) but high GVHD, motivating extension of JAK inhibition through and after transplant — reinforcing that pre-transplant bridging alone may be insufficient in the haplo setting. (novelty: 3)
2026-06-16 — Final analysis of phase 2 clinical trial of ruxolitinib and azacitidine combination therapy in patients with myelodysplastic syndrome/myeloproliferative neoplasms.: Final phase 2 analysis of azacitidine + ruxolitinib in MDS/MPN reports 58% ORR and median OS 26.7 months, with notably favorable survival in the subset proceeding to allogeneic transplant — supporting HMA + ruxolitinib as a viable bridging combination in MDS/MPN overlap patients heading to allo-HCT. (novelty: 3)
2026-06-30 — A systematic review of 47 published cases of extramedullary hematopoiesis in myelofibrosis: clinical patterns, treatment responses, and prognostic implications.: cross-connection with atypical-emh-mf-referral-trigger: Ruxolitinib responsiveness of atypical EMH extends the pre-transplant bridging rationale beyond splenomegaly and constitutional symptoms to extramedullary disease control. (novelty: 3)
2026-08-23 — Sequential High-Dose Ruxolitinib and Low-Dose Splenic Irradiation for Pretransplant Management of Splenomegaly Before Allogeneic Hematopoietic Cell Transplantation With Fludarabine/Busulfan-Based Conditioning in Myelofibrosis.: Small retrospective series (n=9) shows sequential high-dose ruxolitinib followed by low-dose splenic irradiation produces stepwise pretransplant spleen reduction before Flu/Bu allo-HCT, extending high-dose ruxolitinib bridging with a radiation add-on when JAK inhibition alone is insufficient. (novelty: 3)
2026-03-04 — Pacritinib With Standard of Care Azacitidine or Decitabine as a Bridge to Allogeneic Hematopoietic Stem Cell Transplant for Patients With Accelerated and Blast Phase Myeloproliferative Neoplasms: Parallel phase II trial uses pacritinib (rather than ruxolitinib) plus azacitidine or decitabine as a bridge to alloHCT in AP/BP-MPN, suggesting pacritinib may be preferred over ruxolitinib in cytopenic AP/BP patients where ruxolitinib bridging is poorly tolerated. (novelty: 3)
2026-02-19 — Ruxolitinib Before, During and After Hematopoietic Cell Transplant in Older Patients With Myelofibrosis and Myelodysplastic Syndrome/Myeloproliferative Neoplasm Overlap Syndromes: Phase II trial in older MF and MDS/MPN overlap patients carries ruxolitinib bridging through conditioning and post-HCT alongside tacrolimus/methotrexate, supporting continuity of bridging into the peri-transplant window in an older, more comorbid population. (novelty: 3)
2026-03-31 — Momelotinib During and After HCT in Myelofibrosis: Phase I study of momelotinib during and after HCT in MF introduces a JAK1/2/ACVR1 inhibitor as an alternative to ruxolitinib for the peri-transplant window, potentially attractive in patients with anemia where momelotinib’s hepcidin-suppressing activity could complement bridging. (novelty: 3, trial-early) (novelty: 3)
2026-04-20 — Luspatercept in Preventing Poor Erythroid Engraftment for Hematological Malignancies With Moderate to Severe Myelofibrosis: Adjacent to bridging strategies, a planned RCT of post-HSCT luspatercept for poor erythroid engraftment in moderate-to-severe MF suggests TGF-β modulation may complement (rather than replace) JAK-inhibitor bridging by addressing a distinct downstream complication. (novelty: 4)
2026-03-13 — Gecacitinib Pre-, During- and Post-HSCT for Patients With Primary or Secondary Myelofibrosis: Gecacitinib (JAK/ACVR1) is being trialed pre-, during-, and post-HSCT in MF, positioning a dual-pathway JAK inhibitor as a potential alternative to ruxolitinib for the bridging phase of peri-transplant management. (novelty: 3)
2026-04-14 — Peritransplant Ruxolitinib for Patients With Primary and Secondary Myelofibrosis: Phase II peritransplant ruxolitinib trial extends the bridging paradigm by carrying ruxolitinib through conditioning and into the post-transplant period in primary and secondary MF, reinforcing the dual bridging + GVHD-prophylaxis role. (novelty: 3)
2026-03-11 — High Dose Ruxolitinib and Allogeneic Stem Cell Transplantation in Myelofibrosis Patients With Splenomegaly: Early trial evidence suggests high-dose ruxolitinib combined with busulfan conditioning may further reduce splenomegaly and improve transplant outcomes in MF, hinting that dose escalation (rather than standard bridging doses) integrated into conditioning could be beneficial. (novelty: 3)
2026-03-16 — Decitabine With Ruxolitinib, Fedratinib or Pacritinib for the Treatment of Accelerated/Blast Phase Myeloproliferative Neoplasms: Phase II trial is testing decitabine + ruxolitinib (or fedratinib/pacritinib) as pre-transplant bridging in AP/BP MPN, extending ruxolitinib bridging beyond chronic-phase MF into the accelerated/blast phase setting. (novelty: 3, trial-early) (novelty: 3)
April 2, 2 — Peri-Transplant Ruxolitinib Leads to Low GVHD Incidence in Myelofibrosis - OncLive: Early trial data (OncLive report) indicate that extending ruxolitinib into the peri-transplant period — beyond bridging — is associated with low GVHD incidence in MF patients, suggesting a dual role for ruxolitinib (bridging + GVHD prophylaxis). (novelty: 3)