Contributions
Abstract: EP1287
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
Allogeneic stem cell transplantation (HSCT) remains the only curative option for patients with myelofibrosis (MF).
Aims
Investigate the influence of peritransplant variables on transplantation outcomes in patients with MF.
Methods
Retrospective analysis of patients treated with HSCT from 2010 to 2020 in the Department of Haematology at University Hospital Centre Zagreb.
Results
A total of 41 patients (14 women and 27 men) were transplanted, ranging in age from 32 to 65 years (median 54). Thirty (73.2%) had primary and 11 (26.8%) secondary MF. Most of the patients had intermediate or high-risk disease. Eleven patients (26.8%) received stem cells from a related, 28 (68.3%) from an unrelated, and 2 (4.9%) from a haploidentical donor. Except for 5 patients who received myeloablative conditioning (MAC), all others (36 patients, 87.8%) received reduced-intensity conditioning (RIC), in most cases FluBu3ATG. Only 2 patients received bone marrow stem cells, while others received peripheral blood stem cells. The median number of infused CD34+ cells was 6.02x106/kg BW (range 1.93–28.65). A total of 23 patients (56.1%) received ruxolitinib prior to transplantation, and 8 (19.5%) patients received the drug sometime during the post-transplantation period. The cumulative overall survival (OS) after a median follow-up of 574 days (range 18–3834) was 58.9% for the whole group. One patient transplanted from a haploidentical donor died of sepsis in the first weeks after transplantation and another one a year after transplantation after a series of infectious complications. Although not reaching statistical significance, patients transplanted from related donors had a better outcome than those who received a transplant from unrelated donors (OS 81.8% vs 60.7%, p=0.2), patients without splenomegaly pre-transplant compared to those with palpable spleens (OS 81.8% vs 59.3%, p=0.17), and patients who were fit enough to receive MAC compared to the large majority who received RIC (OS 100% vs 58.3%, p=0.07). Neither the diagnosis (primary or secondary MF) nor the number of CD34+ cells infused - over or below the median of 6.36x106/kg BW, had significant effects on outcomes (OS 58.7% vs 56%, p=0.85 and 61.2% vs 54.5%, p=0.9, respectively). Patients with chronic graft-versus-host disease had superior OS compared to patients not experiencing this transplant complication (OS 81.3% vs 54.2%, p=0.04).
Conclusion
Although wider donor availability and JAK inhibitors are making HSCT, the only available curative option for MF accesible to a larger number of patients, efforts should be made to further improve transplantation outcomes. Transplant candidates should be carefully selected with therapeutic interventions before and after transplantation tailored according to specific clinical situations. Trials addressing specific clinical scenarios are warranted.
Keyword(s): Allogeneic hematopoietic stem cell transplant, Myelofibrosis, Ruxolitinib
Abstract: EP1287
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
Allogeneic stem cell transplantation (HSCT) remains the only curative option for patients with myelofibrosis (MF).
Aims
Investigate the influence of peritransplant variables on transplantation outcomes in patients with MF.
Methods
Retrospective analysis of patients treated with HSCT from 2010 to 2020 in the Department of Haematology at University Hospital Centre Zagreb.
Results
A total of 41 patients (14 women and 27 men) were transplanted, ranging in age from 32 to 65 years (median 54). Thirty (73.2%) had primary and 11 (26.8%) secondary MF. Most of the patients had intermediate or high-risk disease. Eleven patients (26.8%) received stem cells from a related, 28 (68.3%) from an unrelated, and 2 (4.9%) from a haploidentical donor. Except for 5 patients who received myeloablative conditioning (MAC), all others (36 patients, 87.8%) received reduced-intensity conditioning (RIC), in most cases FluBu3ATG. Only 2 patients received bone marrow stem cells, while others received peripheral blood stem cells. The median number of infused CD34+ cells was 6.02x106/kg BW (range 1.93–28.65). A total of 23 patients (56.1%) received ruxolitinib prior to transplantation, and 8 (19.5%) patients received the drug sometime during the post-transplantation period. The cumulative overall survival (OS) after a median follow-up of 574 days (range 18–3834) was 58.9% for the whole group. One patient transplanted from a haploidentical donor died of sepsis in the first weeks after transplantation and another one a year after transplantation after a series of infectious complications. Although not reaching statistical significance, patients transplanted from related donors had a better outcome than those who received a transplant from unrelated donors (OS 81.8% vs 60.7%, p=0.2), patients without splenomegaly pre-transplant compared to those with palpable spleens (OS 81.8% vs 59.3%, p=0.17), and patients who were fit enough to receive MAC compared to the large majority who received RIC (OS 100% vs 58.3%, p=0.07). Neither the diagnosis (primary or secondary MF) nor the number of CD34+ cells infused - over or below the median of 6.36x106/kg BW, had significant effects on outcomes (OS 58.7% vs 56%, p=0.85 and 61.2% vs 54.5%, p=0.9, respectively). Patients with chronic graft-versus-host disease had superior OS compared to patients not experiencing this transplant complication (OS 81.3% vs 54.2%, p=0.04).
Conclusion
Although wider donor availability and JAK inhibitors are making HSCT, the only available curative option for MF accesible to a larger number of patients, efforts should be made to further improve transplantation outcomes. Transplant candidates should be carefully selected with therapeutic interventions before and after transplantation tailored according to specific clinical situations. Trials addressing specific clinical scenarios are warranted.
Keyword(s): Allogeneic hematopoietic stem cell transplant, Myelofibrosis, Ruxolitinib