Predicting Survival after Allogeneic Hematopoietic Cell Transplantation in Myelofibrosis: Performance of the Myelofibrosis Transplant Scoring System (MTSS) and Development of a New Prognostic Model.

Abstract

Accurate prognostic tools are crucial to assess the risk/benefit ratio of allogeneic hematopoietic cell transplantation (allo-HCT) in patients with myelofibrosis (MF). We aimed to evaluate the performance of the Myelofibrosis Transplant Scoring System (MTSS) and identify risk factors for survival in a multicenter series of 197 patients with MF undergoing allo-HCT. After a median follow-up of 3.1 years, 47% of patients had died, and the estimated 5-year survival rate was 51%. Projected 5-year risk of nonrelapse mortality and relapse incidence was 30% and 20%, respectively. Factors independently associated with increased mortality were a hematopoietic cell transplantation-specific comorbidity index (HCT-CI) ≥3 and receiving a graft from an HLA-mismatched unrelated donor or cord blood, whereas post-transplant cyclophosphamide (PT-Cy) was associated with improved survival. Donor type was the only parameter included in the MTSS model with independent prognostic value for survival. According to the MTSS, 3-year survival was 62%, 66%, 37%, and 17% for low-, intermediate-, high-, and very high-risk groups, respectively. By pooling together the low- and intermediate-risk groups, as well as the high- and very high-risk groups, we pinpointed 2 categories: standard risk and high risk (25% of the series). Three-year survival was 62% in standard-risk and 25% in high-risk categories (P < .001). We derived a risk score based on the 3 independent risk factors for survival in our series (donor type, HCT-CI, and PT-Cy). The corresponding 5-year survival for the low-, intermediate-, and high-risk categories was 79%, 55%, and 32%, respectively (P < .001). In conclusion, the MTSS model failed to clearly delineate 4 prognostic groups in our series but may still be useful to identify a subset of patients with poor outcome. We provide a simple prognostic scoring system for risk/benefit considerations before transplantation in patients with MF.

• Authors: Juan-Carlos Hernández-Boluda, Arturo Pereira, Alberto Alvarez-Larran, Ana-Africa Martín, Ana Benzaquen, Lourdes Aguirre, Elvira Mora, Pedro González, Jorge Mora, Nieves Dorado, Antonia Sampol, Valentín García-Gutiérrez, Oriana López-Godino, María-Laura Fox, Juan Luis Reguera, Manuel Pérez-Encinas, María-Jesús Pascual, Blanca Xicoy, Rocío Parody, Leslie González-Pinedo, Ignacio Español, Alejandro Avendaño, Juan-Gonzalo Correa, Carlos Vallejo, Manuel Jurado, Irene García-Cadenas, Santiago Osorio, María-Antonia Durán, Fermín Sánchez-Guijo, Francisco Cervantes, José-Luis Piñana
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 26 Issue 12 Pg. 2237-2244 (12 2020) ISSN: 1523-6536 [Electronic] United States
• PMID: 32717433 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Copyright © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.

Topics

• Hematopoietic Stem Cell Transplantation
• Humans
• Primary Myelofibrosis (therapy)
• Prognosis
• Transplantation Conditioning
• Transplantation, Homologous
• Treatment Outcome