Determinants of survival in myelofibrosis patients undergoing allogeneic hematopoietic cell transplantation

• Published in: Leukemia Vol. 35; no. 1; pp. 215 - 224
• Main Authors: Hernández-Boluda, Juan Carlos, Pereira, Arturo, Kröger, Nicolaus, Beelen, Dietrich, Robin, Marie, Bornhäuser, Martin, Angelucci, Emanuele, Vitek, Antonin, Blau, Igor Wolfgang, Niittyvuopio, Riitta, Finke, Jürgen, Cornelissen, Jan J., Passweg, Jakob, Dreger, Peter, Petersen, Eefke, Kanz, Lothar, Sanz, Jaime, Zuckerman, Tsila, Zinger, Nienke, Iacobelli, Simona, Hayden, Patrick, Czerw, Tomasz, McLornan, Donal, Yakoub-Agha, Ibrahim
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.01.2021; Nature Publishing Group; Springer Nature
• Series: Leukemia
• Subjects: 692/308/2171; 692/699/1541/1990/2331; Cancer Research; Care and treatment; Clinical decision making; Complications; Critical Care Medicine; Decision making; Development and progression; Europe; Evaluation; Female; Graft rejection; Graft vs Host Disease - etiology; Graft-versus-host reaction; Grafting; Grafts; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Histocompatibility antigen HLA; Humans; Intensive; Internal Medicine; Kaplan-Meier Estimate; Life Sciences; Male; Medicine; Medicine & Public Health; Mortality; Myelofibrosis; Oncology; Primary Myelofibrosis - diagnosis; Primary Myelofibrosis - epidemiology; Primary Myelofibrosis - mortality; Primary Myelofibrosis - therapy; Prognosis; Proportional Hazards Models; Recurrence; Registries; Retrospective Studies; Risk; Stem cell transplantation; Survival; Transplantation; Transplantation, Homologous; Transplants & implants; Treatment Outcome; Europe; Spain
• ISSN: 0887-6924; 1476-5551; 1476-5551
• DOI: 10.1038/s41375-020-0815-z

We aimed to evaluate the determinants of survival in myelofibrosis patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) and to describe factors predicting the main post-HCT complications. This retrospective study by the European Society for Blood and Marrow Transplantation included 2916 myelofibrosis patients who underwent first allo-HCT from an HLA-identical sibling or unrelated donor between 2000 and 2016. After a median follow-up of 4.7 years from transplant, projected median survival of the series was 5.3 years. Factors independently associated with increased mortality were age ≥ 60 years and Karnofsky Performance Status <90% at transplant, and occurrence of graft failure, grades III–IV acute graft-vs.-host disease (aGVHD), and disease progression/relapse during follow-up. The opposing effects of chronic graft-vs.-host disease (GVHD) on non-relapse mortality and relapse incidence resulted in a neutral influence on survival. Graft failure increased in unrelated donor recipients and decreased with myeloablative conditioning (MAC) and negative donor/recipient cytomegalovirus serostatus. Risk of grades III–IV aGVHD was higher with unrelated donors and decreased with MAC. Relapse incidence tended to be higher in patients with intermediate-2/high-risk DIPSS categories and to decrease in CALR -mutated patients. Acute and chronic GVHD reduced the subsequent risk of relapse. This information has potential implications for patient counseling and clinical decision-making.