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Impact of donor type on transplant outcomes in patients with MF
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A Center for International Blood and Marrow Transplant Research (CIBMTR) registry-based study evaluated the impact of donor type on allogeneic hematopoietic stem cell transplantation (allo-HSCT) outcomes in adult patients with myelofibrosis (MF).1 This analysis included 1,032 patients who received allo-HSCT with either a matched sibling donor (MSD; n = 298), haploidentical donor (Haplo; n = 119), matched unrelated donor (MUD; n = 551), or mismatched unrelated donor (MMUD; n = 64) between January 2013 and December 2019. Results from this analysis were published in Blood Advances by Jain et al.1 |
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The estimated 3-year overall survival (OS) rates were 68.8%, 59%, 61.3%, and 55.2% with MSD, Haplo, MUD, and MMUD, respectively (p = 0.03). |
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Multivariable analysis demonstrated that allo-HSCT with MSD was associated with improved OS in the first 3 months post-transplant (Haplo: hazard ratio [HR], 5.79; 95% confidence interval [CI], 2.54–13.20; MUD: HR, 4.48; 95% CI, 2.25–8.92; MMUD: HR, 5.24; 95% CI, 1.49–18.42; p < 0.001). There was no significant OS difference between the three non-MSD donor types in the first 3 months, and no difference between all donor types beyond 3 months post transplant. |
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The use of MSD was associated with a lower incidence of graft failure than Haplo (HR, 6.11; 95% CI, 2.98–12.54; p <0.001) and MUD (HR, 2.33; 95% CI, 1.20–4.51; p = 0.01), and lower non-relapse mortality (NRM) than Haplo (HR, 1.71; 95% CI, 1.09–2.68), MUD (HR, 1.58; 95% CI, 1.14–2.18), and MMUD (HR, 1.71; 05% CI, 0.98–2.97; p = 0.03). The NRM rates were similar between patients who received allo-HSCT with Haplo, MUD, and MMUD. |
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Relapse and disease-free survival were similar between all donor types. Additionally, in the subset of patients who underwent allo-HSCT within 24 months of diagnosis (n = 481), OS was not associated with donor type. |
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The improved survival in the early post-transplant period with allo-HSCT with MSD was mainly driven by improved engraftment and lower NRM. Results suggest that allo-HSCT with a Haplo donor and post-transplant cyclophosphamide in patients with MF is a viable alternative to MUD and MMUD, particularly for ethnic minorities underrepresented in donor registries. Additionally, timely transplantation without delaying for a fully matched donor is recommended to improve outcomes. |
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On average, how many patients with myelofibrosis do you see in a month?
