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

Hernández-Boluda, Juan-Carlos, Pereira, Arturo, Kröger, Nicolaus, Cornelissen, Jan J., Finke, Jürgen, Beelen, Dietrich, Witte, Moniek, Wilson, Keith, Platzbecker, Uwe, Sengeloev, Henrik, Blaise, Didier, Einsele, Hermann, Sockel, Katja, Krüger, William, Lenhoff, Stig, Salaroli, Adriano, Martin, Hans, García-Gutiérrez, Valentín, Pavone, Vicenzo, Alvarez-Larrán, Alberto, Raya, José-María, Zinger, Nienke, Gras, Luuk, Hayden, Patrick, Czerw, Tomasz, P. McLornan, Donal and Yakoub-Agha, Ibrahim 2021. Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: A study of the chronic malignancies working party of EBMT and the Spanish Myelofibrosis Registry. American Journal of Hematology 96 (10) , pp. 1186-1194. 10.1002/ajh.26279

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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.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Additional Information: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License
Publisher: Wiley
ISSN: 0361-8609
Date of First Compliant Deposit: 14 March 2022
Date of Acceptance: 17 June 2021
Last Modified: 15 Mar 2022 16:37

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