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HCT Tied to Long-Term Survival and Early Death in Certain Patients With MF
Study findings suggest that there is a long-term survival advantage of allogeneic hematopoietic cell transplantation (HCT) in certain patients with myelofibrosis (MF), but at the expense of possible early death (Blood Adv. 2020;4[9]:1965-1973).
According to Krisstina Gowin, DO, Division of Hematology and Oncology, University of Arizona, Tucson, and colleagues, allogeneic HCT is the only curative therapy for patients with MF.
In a retrospective, multi-center study, Dr Gowin et al compared overall survival (OS) between patients with MF who did (n = 551) and did not (n = 1377) undergo allogeneic HCT. They also sought to assess the link between patient disease and treatment-related factors and differences in survival.
The Dynamic International Prognostic Scoring System (DIPSS) was used to stratify survival analysis, in turn revealing that HCT during the first year of treatment assignment was tied to inferior OS compared with non-HCT, because of an upfront risk for transplant-related mortality (TRM; 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).
Correspondingly, OS was found to be superior with non-HCT versus HCT therapies in the first-year after treatment assignment because of upfront TRM risk in the DIPSS low-risk MF arm (HR, 0.16; P = .006).
Of note, the investigators did not observe a significant difference in OS after 1 year (HR, 1.38; P = .451), although they did see an OS advantage with HCT therapy in patients with Int-1 and higher DIPSS scores after 1 year of treatment assignment (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,” Dr Gowin and colleagues reported.—Hina Porcelli
