Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: a study of the Chronic Malignancies Working Party of EBMT and the Spanish Myelofibrosis Registry. - Université de Lille Accéder directement au contenu
Article Dans Une Revue American Journal of Hematology Année : 2021

Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: a study of the Chronic Malignancies Working Party of EBMT and the Spanish Myelofibrosis Registry.

J. C. Hernández-Boluda
  • Fonction : Auteur
A. Pereira
  • Fonction : Auteur
N. Kröger
  • Fonction : Auteur
J. J. Cornelissen
  • Fonction : Auteur
J. Finke
  • Fonction : Auteur
D. Beelen
  • Fonction : Auteur
M. de Witte
  • Fonction : Auteur
K. Wilson
  • Fonction : Auteur
U. Platzbecker
  • Fonction : Auteur
H. Sengeloev
  • Fonction : Auteur
D. Blaise
H. Einsele
  • Fonction : Auteur
K. Sockel
  • Fonction : Auteur
W. Krüger
  • Fonction : Auteur
S. Lenhoff
  • Fonction : Auteur
A. Salaroli
  • Fonction : Auteur
H. Martin
  • Fonction : Auteur
V. García-Gutiérrez
  • Fonction : Auteur
V. Pavone
  • Fonction : Auteur
A. Alvarez-Larrán
  • Fonction : Auteur
J. M. Raya
  • Fonction : Auteur
N. Zinger
  • Fonction : Auteur
L. Gras
  • Fonction : Auteur
P. Hayden
  • Fonction : Auteur
T. Czerw
  • Fonction : Auteur
D. Mclornan
  • Fonction : Auteur

Résumé

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.
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Dates et versions

hal-04479221 , version 1 (28-02-2024)

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J. C. Hernández-Boluda, A. Pereira, N. Kröger, J. J. Cornelissen, J. Finke, et al.. 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, 2021, American Journal of Hematology, ⟨10.1002/ajh.26279⟩. ⟨hal-04479221⟩

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