Allo-transplant is still the only cure in myelofibrosis — and still carries 20–30% TRM, for the minority who are eligible. So what happens when CALR-directed therapies arrive? New review out today in Bone Marrow Transplantation, open access. We work through the landscape — peptide vaccines, the Fc-silenced mAb INCA033989, bispecifics, a first-in-class ADC, and RPG4 CAR-T — and ask what each does to the transplant decision. Our take: signalling blockade is the most clinically mature, but blocking mutCALR–TpoR likely won’t clear the clone. Cytotoxic approaches have the mechanism for that depth, but no clinical data yet. High-risk patients should still go to transplant. The near-term opportunities are earlier disease, transplant-ineligible patients, and post-transplant MRD. One unsolved problem: there’s no validated definition of progression on a disease-modifying immunotherapy. IWG-MRT was written for cytoreduction, not this. Led by Amy McDonald with contributions from all team @DrLornan @drclaireroddie Jonathan Lambert et al 👏 #MPNsm nature.com/articles/s41409-0…