TY - JOUR

T1 - Allogeneic hematopoietic cell transplantation in older myelofibrosis patients

T2 - A study of the chronic malignancies working party of EBMT and the Spanish Myelofibrosis Registry

AU - Hernández-Boluda, Juan Carlos

AU - Pereira, Arturo

AU - Kröger, Nicolaus

AU - Cornelissen, Jan J.

AU - Finke, Jürgen

AU - Beelen, Dietrich

AU - de Witte, Moniek

AU - Wilson, Keith

AU - Platzbecker, Uwe

AU - Sengeloev, Henrik

AU - Blaise, Didier

AU - Einsele, Hermann

AU - Sockel, Katja

AU - Krüger, William

AU - Lenhoff, Stig

AU - Salaroli, Adriano

AU - Martin, Hans

AU - García-Gutiérrez, Valentín

AU - Pavone, Vicenzo

AU - Alvarez-Larrán, Alberto

AU - Raya, José María

AU - Zinger, Nienke

AU - Gras, Luuk

AU - Hayden, Patrick

AU - Czerw, Tomasz

AU - P. McLornan, Donal

AU - Yakoub-Agha, Ibrahim

N1 - Publisher Copyright: © 2021 The Authors. American Journal of Hematology published by Wiley Periodicals LLC.

PY - 2021

Y1 - 2021

N2 - Allogeneic hematopoietic cell transplantation (allo-HCT) is increasingly used in older myelofibrosis (MF) patients, but its risk/benefit ratio compared to non-transplant approaches has not been evaluated in this population. We analyzed the outcomes of allo-HCT in 556 MF patients aged ≥65 years from the EBMT registry, and determined the excess mortality over the matched general population of MF patients ≥65 years managed with allo-HCT (n = 556) or conventional drug treatment (n = 176). The non-transplant cohort included patients with intermediate-2 or high risk DIPSS from the Spanish Myelofibrosis Registry. After a median follow-up of 3.4 years, the estimated 5-year survival rate, non-relapse mortality (NRM), and relapse incidence after transplantation was 40%, 37%, and 25%, respectively. Busulfan-based conditioning was associated with decreased mortality (HR: 0.7, 95% CI: 0.5–0.9) whereas the recipient CMV+/donor CMV- combination (HR: 1.7, 95% CI: 1.2–2.4) and the JAK2 mutated genotype (HR: 1.9, 95% CI: 1.1–3.5) predicted higher mortality. Busulfan-based conditioning correlated with improved survival due to less NRM, despite its higher relapse rate when compared with melphalan-based regimens. Excess mortality was higher in transplanted patients than in the non-HCT cohort in the first year of follow-up (ratio: 1.93, 95% CI: 1.13–2.80), whereas the opposite occurred between the fourth and eighth follow-up years (ratio: 0.31, 95% CI: 0.18–0.53). Comparing the excess mortality of the two treatments, male patients seemed to benefit more than females from allo-HCT, mainly due to their worse prognosis with non-transplant approaches. These findings could potentially enhance counseling and treatment decision-making in elderly transplant-eligible MF patients.

AB - Allogeneic hematopoietic cell transplantation (allo-HCT) is increasingly used in older myelofibrosis (MF) patients, but its risk/benefit ratio compared to non-transplant approaches has not been evaluated in this population. We analyzed the outcomes of allo-HCT in 556 MF patients aged ≥65 years from the EBMT registry, and determined the excess mortality over the matched general population of MF patients ≥65 years managed with allo-HCT (n = 556) or conventional drug treatment (n = 176). The non-transplant cohort included patients with intermediate-2 or high risk DIPSS from the Spanish Myelofibrosis Registry. After a median follow-up of 3.4 years, the estimated 5-year survival rate, non-relapse mortality (NRM), and relapse incidence after transplantation was 40%, 37%, and 25%, respectively. Busulfan-based conditioning was associated with decreased mortality (HR: 0.7, 95% CI: 0.5–0.9) whereas the recipient CMV+/donor CMV- combination (HR: 1.7, 95% CI: 1.2–2.4) and the JAK2 mutated genotype (HR: 1.9, 95% CI: 1.1–3.5) predicted higher mortality. Busulfan-based conditioning correlated with improved survival due to less NRM, despite its higher relapse rate when compared with melphalan-based regimens. Excess mortality was higher in transplanted patients than in the non-HCT cohort in the first year of follow-up (ratio: 1.93, 95% CI: 1.13–2.80), whereas the opposite occurred between the fourth and eighth follow-up years (ratio: 0.31, 95% CI: 0.18–0.53). Comparing the excess mortality of the two treatments, male patients seemed to benefit more than females from allo-HCT, mainly due to their worse prognosis with non-transplant approaches. These findings could potentially enhance counseling and treatment decision-making in elderly transplant-eligible MF patients.

U2 - 10.1002/ajh.26279

DO - 10.1002/ajh.26279

M3 - Journal article

C2 - 34152630

AN - SCOPUS:85109402664

VL - 96

SP - 1186

EP - 1194

JO - American Journal of Hematology

JF - American Journal of Hematology

SN - 0361-8609

IS - 10

ER -