Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: A study of the chronic malignancies working party of EBMT and the Spanish Myelofibrosis Registry
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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; Beelen, Dietrich; de 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; Yakoub-Agha, Ibrahim.
in: AM J HEMATOL, Jahrgang 96, Nr. 10, 01.10.2021, S. 1186-1194.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: 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 - 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 - © 2021 The Authors. American Journal of Hematology published by Wiley Periodicals LLC.
PY - 2021/10/1
Y1 - 2021/10/1
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.
KW - Age Factors
KW - Aged
KW - Cohort Studies
KW - Female
KW - Hematopoietic Stem Cell Transplantation
KW - Humans
KW - Male
KW - Primary Myelofibrosis/epidemiology
KW - Registries
KW - Spain/epidemiology
KW - Survival Analysis
KW - Transplantation, Homologous
U2 - 10.1002/ajh.26279
DO - 10.1002/ajh.26279
M3 - SCORING: Journal article
C2 - 34152630
VL - 96
SP - 1186
EP - 1194
JO - AM J HEMATOL
JF - AM J HEMATOL
SN - 0361-8609
IS - 10
ER -
