Predicting Survival after Allogeneic Hematopoietic Cell Transplantation in Myelofibrosis: Performance of the Myelofibrosis Transplant Scoring System (MTSS) and Development of a New Prognostic Model
Por:
Hernandez-Boluda, JC, Pereira, A, Alvarez-Larran, A, Martin, AA, Benzaquen, A, Aguirre, L, Mora, E, Gonzalez, P, Mora, J, Dorado, N, Sampol, A, Garcia-Gutierrez, V, Lopez-Godino, O, Fox, ML, Reguera, JL, Perez-Encinas, M, Pascual, MJ, Xicoy, B, Parody, R, Gonzalez-Pinedo, L, Espanol, I, Avendano, A, Correa, JG, Vallejo, C, Jurado, M, Garcia-Cadenas, I, Osorio, S, Duran, MA, Sanchez-Guijo, F, Cervantes, F, Pinana, JL
Publicada:
1 dic 2020
Resumen:
Accurate prognostic tools are crucial to assess the risk/benefit ratio of allogeneic hematopoietic cell transplantation (allo-HCT) in patients with myelofibrosis (MF). We aimed to evaluate the performance of the Myelofibrosis Transplant Scoring System (MTSS) and identify risk factors for survival in a multicenter series of 197 patients with MF undergoing allo-HCT. After a median follow-up of 3.1 years, 47% of patients had died, and the estimated 5 year survival rate was 51%. Projected 5-year risk of nonrelapse mortality and relapse incidence was 30% and 20%, respectively. Factors independently associated with increased mortality were a hematopoietic cell transplantation-specific comorbidity index (HCT-CI) 3 and receiving a graft from an HLA-mismatched unrelated donor or cord blood, whereas post-transplant cyclophosphamide (PT-Cy) was associated with improved survival. Donor type was the only parameter included in the MTSS model with independent prognostic value for survival. According to the MTSS, 3-year survival was 62%, 66%, 37%, and 17% for low-, intermediate-, high-, and very high-risk groups, respectively. By pooling together the lowand intermediate-risk groups, as well as the highand very high-risk groups, we pinpointed 2 categories: standard risk and high risk (25% of the series). Three-year survival was 62% in standard-risk and 25% in high-risk categories (P < .001). We derived a risk score based on the 3 independent risk factors for survival in our series (donor type, HCT-CI, and PT-Cy). The corresponding 5-year survival for the low-, intermediate-, and high-risk categories was 79%, 55%, and 32%, respectively (P < .001).
In conclusion, the MTSS model failed to clearly delineate 4 prognostic groups in our series but may still be useful to identify a subset of patients with poor outcome. We provide a simple prognostic scoring system for risk/benefit considerations before transplantation in patients with MF. (C) 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
Filiaciones:
Hernandez-Boluda, JC:
Univ Valencia, Hosp Clin Univ, Hematol Dept, INCLIVA, Valencia, Spain
Pereira, A:
Hosp Clin Barcelona, Hemotherapy & Hemostasis Dept, Barcelona, Spain
Alvarez-Larran, A:
Univ Barcelona, Hosp Clin, Barcelona Inst Josep Carreras, IDIBAPS,Hematopoiet Stem Cell Transplantat Unit, Barcelona, Spain
Martin, AA:
Hosp Univ Salamanca, Hematol Dept, IBSAL, Salamanca, Spain
Benzaquen, A:
Univ Valencia, Hosp Clin Univ, Hematol Dept, INCLIVA, Valencia, Spain
Aguirre, L:
Hosp Univ Donostia, Hematol Dept, San Sebastian, Spain
Mora, E:
Hosp La Fe, Hematol Dept, IIS La Fe, Valencia, Spain
Gonzalez, P:
Hosp Univ Virgen de las Nieves, Hematol Dept, Granada, Spain
Mora, J:
Autonomous Univ Barcelona UAB, Hematol Dept, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau, Barcelona, Spain
Autonomous Univ Barcelona UAB, Jose Carreras Leukemia Res Inst, Barcelona, Spain
Dorado, N:
Hosp Gregorio Maranon, Gregorio Maranon Hlth Res Inst IiSGM, Hematol Dept, Madrid, Spain
Sampol, A:
Hosp Son Espases, Hematol Dept, Mallorca, Spain
Garcia-Gutierrez, V:
Hosp Ramon & Cajal, Hematol Dept, Madrid, Spain
Lopez-Godino, O:
Hosp Univ Morales Meseguer, Ctr Reg Hemodonac, Inst Murciano Invest Biomed Arrixaca, Hematol & Med Oncol Dept, Murcia, Spain
Fox, ML:
Univ Autonoma Barcelona, Hosp Univ Vall dHebron, Vall dHebron Inst Oncol VHIO, Hematol Dept, Barcelona, Spain
Reguera, JL:
Hosp Virgen del Rocio, Hematol Dept, Seville, Spain
Perez-Encinas, M:
Hosp Clin Univ, Hematol Dept, Santiago De Compostela, Spain
Pascual, MJ:
Hosp Reg, Hematol Dept, Malaga, Spain
Xicoy, B:
Autonomous Univ Barcelona, Inst Catala Oncol, Josep Carreras Leukemia Res Inst, Hematol Dept,Hosp Germans Trias & Pujol, Badalona, Spain
Parody, R:
Hosp Duran & Reynals, Inst Catala Oncol, Hematol Dept, Barcelona, Spain
Gonzalez-Pinedo, L:
Hosp Dr Negrin, Hematol Dept, Las Palmas Gran Canaria, Spain
Espanol, I:
Hosp Virgen Arrixaca, Hematol Dept, Murcia, Spain
Avendano, A:
Hosp Univ Salamanca, Hematol Dept, IBSAL, Salamanca, Spain
Correa, JG:
Univ Barcelona, Hosp Clin, Barcelona Inst Josep Carreras, IDIBAPS,Hematopoiet Stem Cell Transplantat Unit, Barcelona, Spain
Vallejo, C:
Hosp Univ Donostia, Hematol Dept, San Sebastian, Spain
Jurado, M:
Hosp Univ Virgen de las Nieves, Hematol Dept, Granada, Spain
Garcia-Cadenas, I:
Autonomous Univ Barcelona UAB, Hematol Dept, Hosp Santa Creu & St Pau, Biomed Res Inst IIB St Pau, Barcelona, Spain
Autonomous Univ Barcelona UAB, Jose Carreras Leukemia Res Inst, Barcelona, Spain
Osorio, S:
Hosp Gregorio Maranon, Gregorio Maranon Hlth Res Inst IiSGM, Hematol Dept, Madrid, Spain
Duran, MA:
Hosp Son Espases, Hematol Dept, Mallorca, Spain
Sanchez-Guijo, F:
Hosp Univ Salamanca, Hematol Dept, IBSAL, Salamanca, Spain
Cervantes, F:
Univ Barcelona, Hosp Clin, Barcelona Inst Josep Carreras, IDIBAPS,Hematopoiet Stem Cell Transplantat Unit, Barcelona, Spain
Pinana, JL:
Hosp La Fe, Hematol Dept, IIS La Fe, Valencia, Spain
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