Chronic leukaemia and other myeloproliferative disorders ePoster with Audio

O062 - DETERMINANTS OF SURVIVAL IN MYELOFIBROSIS PATIENTS UNDERGOING ALLOGENEIC HEMATOPOIETIC CELL TRANSPLANTATION: A STUDY BY THE CHRONIC MALIGNANCIES WORKING PARTY OF EBMT (ID 1130)

Authors
  • P. Dreger
  • L. Kanz
  • E. Petersen
  • S. Iacobelli
  • N. Zinger
  • T. Zuckerman
  • J. Sanz
  • I. Yakoub-Agha
  • P. Hayden
  • T. Czerw
  • D. McLornan
  • E. Angelucci
  • M. Bornhäuser
  • M. Robin
  • D. Beelen
  • J. Hernández-Boluda
  • A. Pereira
  • N. Kröger
  • J. Finke
  • J. Passweg
  • J. Cornelissen
  • A. Vitek
  • R. Niittyvuopio
  • I. Blau

Abstract

Background: A large multicenter retrospective study has been conducted to evaluate the main determinants of survival in transplanted patients with myelofibrosis (MF) and to describe the predictive factors for the main complications after allogeneic hematopoietic cell transplantation (allo-HCT).
 

Methods: This study by the European Society for Blood and Marrow Transplantation (EBMT) included 2916 MF patients who underwent first allo-HCT from an HLA-identical sibling or unrelated donor between January 2000 and December 2016. Primary endpoints were survival, non-relapse mortality (NRM), graft failure, disease progression/relapse, and acute and chronic graft-versus-host disease (GVHD). Period of first allo-HCT, patients and donor characteristics, disease risk profile, transplantation modalities, and the main post-transplant complications were taken into account for the analysis of factors predicting survival. Time-dependent variables were considered only after the first transplant and were analyzed by the time-span splitting method. Multivariate analyses of patient- or procedure-related factors predicting the post-transplant landmark events were done within the framework of competing risks by the method of Fine & Gray. To account for multiple comparisons, statistical significance was set at a p value < 0.01.
 

Results: After a median follow-up of 4.7 years (IQR: 4.4-5.0), 1381 patients (47%) had died. Projected median survival was 5.3 years (95% CI: 4.1-6.6). Factors independently associated with increased mortality were age ≥ 60 years and Karnofsky Performance Status < 90% at transplant, and occurrence of graft failure, grade III-IV acute GVHD, and disease progression/relapse during follow-up. The divergent effects on NRM and relapse incidence of chronic GVHD resulted in a neutral influence on survival. Figure 1 shows the unadjusted survival curves for age 60 years or more, graft failure, grade III-IV acute GVHD, and disease relapse/progression. Graft failure increased in recipients of unrelated donors and decreased with myeloablative conditioning (MAC) and negative cytomegalovirus serostatus of both donor and recipient. Risk of grade III-IV acute GVHD was higher in recipients of unrelated donors and decreased with MAC. Risk of disease progression or relapse tended to be higher in patients with intermediate-2 and high risk DIPSS categories and to decrease in CALR-mutated patients. Acute and chronic GVHD reduced the subsequent risk of relapse.
 

Conclusions: We have characterized the prognostic significance of the main landmark events occurring after allo-HCT in MF patients and the predictive factors for these events. This information has potential implications for patient counseling and clinical decision-making.


[Figure 1. Unadjusted survival by risk factor after transplant in 2916 patients with myelofibrosis]


Disclosure: Nothing to declare

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