Survival following allogeneic transplant in patients with myelofibrosis.

Abstract

Allogeneic hematopoietic cell transplantation (HCT) is the only curative therapy for myelofibrosis (MF). In this large multicenter retrospective study, overall survival (OS) in MF patients treated with allogeneic HCT (551 patients) and without HCT (non-HCT) (1377 patients) was analyzed with Cox proportional hazards model. Survival analysis stratified by the Dynamic International Prognostic Scoring System (DIPSS) revealed that the first year of treatment arm assignment, due to upfront risk of transplant-related mortality (TRM), HCT was associated with inferior OS compared with non-HCT (non-HCT vs HCT: DIPSS intermediate 1 [Int-1]: hazard ratio [HR] = 0.26, P < .0001; DIPSS-Int-2 and higher: HR, 0.39, P < .0001). Similarly, in the DIPSS low-risk MF group, due to upfront TRM risk, OS was superior with non-HCT therapies compared with HCT in the first-year post treatment arm assignment (HR, 0.16, P = .006). However, after 1 year, OS was not significantly different (HR, 1.38, P = .451). Beyond 1 year of treatment arm assignment, an OS advantage with HCT therapy in Int-1 and higher DIPSS score patients was observed (non-HCT vs HCT: DIPSS-Int-1: HR, 2.64, P < .0001; DIPSS-Int-2 and higher: HR, 2.55, P < .0001). In conclusion, long-term OS advantage with HCT was observed for patients with Int-1 or higher risk MF, but at the cost of early TRM. The magnitude of OS benefit with HCT increased as DIPSS risk score increased and became apparent with longer follow-up.

• Authors: Krisstina Gowin, Karen Ballen, Kwang Woo Ahn, Zhen-Huan Hu, Haris Ali, Murat O Arcasoy, Rebecca Devlin, Maria Coakley, Aaron T Gerds, Michael Green, Vikas Gupta, Gabriela Hobbs, Tania Jain, Malathi Kandarpa, Rami Komrokji, Andrew T Kuykendall, Kierstin Luber, Lucia Masarova, Laura C Michaelis, Sarah Patches, Ashley C Pariser, Raajit Rampal, Brady Stein, Moshe Talpaz, Srdan Verstovsek, Martha Wadleigh, Vaibhav Agrawal, Mahmoud Aljurf, Miguel Angel Diaz, Belinda R Avalos, Ulrike Bacher, Asad Bashey, Amer M Beitinjaneh, Jan Cerny, Saurabh Chhabra, Edward Copelan, Corey S Cutler, Zachariah DeFilipp, Shahinaz M Gadalla, Siddhartha Ganguly, Michael R Grunwald, Shahrukh K Hashmi, Mohamed A Kharfan-Dabaja, Tamila Kindwall-Keller, Nicolaus Kröger, Hillard M Lazarus, Jane L Liesveld, Mark R Litzow, David I Marks, Sunita Nathan, Taiga Nishihori, Richard F Olsson, Attaphol Pawarode, Jacob M Rowe, Bipin N Savani, Mary Lynn Savoie, Sachiko Seo, Melhem Solh, Roni Tamari, Leo F Verdonck, Jean A Yared, Edwin Alyea, Uday Popat, Ronald Sobecks, Bart L Scott, Ryotaro Nakamura, Ruben Mesa, Wael Saber
• Journal: Blood advances (Blood Adv) Vol. 4 Issue 9 Pg. 1965-1973 (05 12 2020) ISSN: 2473-9537 [Electronic] United States
• PMID: 32384540 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)
• Copyright: © 2020 by The American Society of Hematology.

Topics

• Hematopoietic Stem Cell Transplantation
• Humans
• Primary Myelofibrosis (therapy)
• Prognosis
• Retrospective Studies
• Transplantation, Homologous