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

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

15 Citations (Scopus)
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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
Pages (from-to)1186-1194
Number of pages9
JournalAmerican Journal of Hematology
Volume96
Issue number10
DOIs
Publication statusPublished - 21 Jun 2021

Bibliographical note

ACKNOWLEDGMENTS:
We are indebted to all centers participating in the EBMT and GEMFIN databases. The list of contributing centers is shown in the supplemental material.

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

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