Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: A study of the chronic malignancies working party of EBMT and the Spanish Myelofibrosis Registry

Juan-Carlos Hernández-Boluda, Arturo Pereira, Nicolaus Kröger, Jan J Cornelissen, Jürgen Finke, Dietrich Beelen, Moniek de Witte, Keith Wilson, Uwe Platzbecker, Henrik Sengeloev, Didier Blaise, Hermann Einsele, Katja Sockel, William Krüger, Stig Lenhoff, Adriano Salaroli, Hans Martin, Valentín García-Gutiérrez, Vicenzo Pavone, Alberto Alvarez-LarránJosé-María Raya, Nienke Zinger, Luuk Gras, Patrick Hayden, Tomasz Czerw, Donal P McLornan, Ibrahim Yakoub-Agha

Abstract

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.

Original languageEnglish
JournalAmerican Journal of Hematology
Volume96
Issue number10
Pages (from-to)1186-1194
Number of pages9
ISSN0361-8609
DOIs
Publication statusPublished - 1 Oct 2021

Keywords

  • Age Factors
  • Aged
  • Cohort Studies
  • Female
  • Hematopoietic Stem Cell Transplantation
  • Humans
  • Male
  • Primary Myelofibrosis/epidemiology
  • Registries
  • Spain/epidemiology
  • Survival Analysis
  • Transplantation, Homologous

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