According to data presented by Moazzam Shahzad, MD, H. Lee Moffitt Cancer Center, University of South Florida, Tampa, Florida, at the 2024 American Society of Hematology (ASH) Annual Meeting & Exposition in San Diego, California, outcomes after allogeneic HCT (alloHCT) were found to be acceptable among older patients with myelofibrosis (MF), with a 2-year survival rate of 59%.

Allogeneic hematopoietic stem cell transplantation exists as the only curative option for patients with myelofibrosis (MF), a myeloproliferative neoplasm that often presents among the elderly population.“However, alloHCT carries significant morbidity in older patients,” explained Shahzad and colleagues, “Our study aims to determine the clinical factors that can help predict alloHCT outcomes in patients over 70 years.”

To determine this, investigators assessed the P-5646 dataset from the Center for International Blood and Marrow Transplant Research (CIBMTR), which included 872 patients with chronic-phase MF who received alloHCT from 2008 to 2019. For this research, the outcomes of interest included overall survival (OS), disease-free survival (DFS), graft-versus-host disease (GVHD) free relapse-free survival (GRFS), acute graft-versus-host disease (aGVHD), chronic GVHD (cGVHD), relapse rate, and non-relapse mortality (NRM) in an older subgroup including age 70 years or above. OS, DFS, and GRFS were censored at 24 months per the dataset. Hazard ratios (HR) with 95% confidence intervals (CI) were determined using univariate and multivariate Cox regression analyses were performed. Statistical analysis was conducted using R version 4.3.2, with statistical significance defined as p <0.05.

Investigators identified 51 patients from the dataset with a median age at alloHCT of 71.8 years. The median time from diagnosis to transplant was 27.3 months, and splenomegaly before HCT was present in 54% of patients, while ruxolitinib was used before HCT in 69% of patients. The MF Dynamic International Prognostic Scoring System (DIPSS)-plus risk categories were intermediate-1, intermediate-2, and high-risk.They utilized matched unrelated donors (MUD, 82%), matched related donors (MRD, 12%), and mismatched unrelated donors (MMUD, 6%) patients, respectively. Most (94.1%) of grafts were from peripheral blood stem cells. The 24-month OS, DFS, and GRFS rates were demonstrated to be 58.8%, 30.6%, and 12.2%, respectively.

Investigators identified trends for inferior OS and inferior DFS among Hispanic patients, which was a significant predictor after multivariate adjustments. The use of MMUD was associated with significantly inferior OS, DFS, and GRFS compared to HLA-identical sibling donors, and only impact on OS remained significant after multivariate adjustments. They did not identify any association between clinical factors and other outcomes.

“Outcomes after allogeneic HCT are acceptable in elderly patients with MF, with a 2-year survival rate of 59%,” concluded Shahzad and colleagues.

“Patients of Hispanic ethnicity and the use of MMUD were associated with inferior outcomes. Careful patient selection and use of matched donors are suggested,” they added.

Source:

Shahzad M, Kashif Amin M, Ponvilawan B, et al. Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Older Patients Aged over 70 Years with Myelofibrosis. Dec 7-10, 2024; San Diego, CA. Abstract: 2172