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Survival following allogeneic transplant in patients with myelofibrosis. | LitMetric

AI Article Synopsis

  • - Allogeneic hematopoietic cell transplantation (HCT) is the only real cure for myelofibrosis (MF), but a study showed that in the first year, patients receiving HCT had lower overall survival (OS) compared to those treated without HCT due to the risk of transplant-related mortality (TRM).
  • - For patients classified as low-risk (DIPSS low-risk), the study found they had better OS with non-HCT treatments in the first year, but after that, the differences in OS between HCT and non-HCT treatments leveled out.
  • - Long-term, HCT started showing a survival advantage for patients with higher risk scores (DIPSS Int-1 and

Article Abstract

Allogeneic hematopoietic cell transplantation (HCT) is the only curative therapy for myelofibrosis (MF). In this large multicenter retrospective study, overall survival (OS) in MF patients treated with allogeneic HCT (551 patients) and without HCT (non-HCT) (1377 patients) was analyzed with Cox proportional hazards model. Survival analysis stratified by the Dynamic International Prognostic Scoring System (DIPSS) revealed that the first year of treatment arm assignment, due to upfront risk of transplant-related mortality (TRM), HCT was associated with inferior OS compared with non-HCT (non-HCT vs HCT: DIPSS intermediate 1 [Int-1]: hazard ratio [HR] = 0.26, P < .0001; DIPSS-Int-2 and higher: HR, 0.39, P < .0001). Similarly, in the DIPSS low-risk MF group, due to upfront TRM risk, OS was superior with non-HCT therapies compared with HCT in the first-year post treatment arm assignment (HR, 0.16, P = .006). However, after 1 year, OS was not significantly different (HR, 1.38, P = .451). Beyond 1 year of treatment arm assignment, an OS advantage with HCT therapy in Int-1 and higher DIPSS score patients was observed (non-HCT vs HCT: DIPSS-Int-1: HR, 2.64, P < .0001; DIPSS-Int-2 and higher: HR, 2.55, P < .0001). In conclusion, long-term OS advantage with HCT was observed for patients with Int-1 or higher risk MF, but at the cost of early TRM. The magnitude of OS benefit with HCT increased as DIPSS risk score increased and became apparent with longer follow-up.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7218417PMC
http://dx.doi.org/10.1182/bloodadvances.2019001084DOI Listing

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