Survival outcomes in patients with MF undergoing transplantation: Role of comorbidities and BMI

For patients with myelofibrosis (MF), transplant suitability is determined by several factors, including age, disease status, comorbidities, performance status, and donor availability, and is currently, based on the Myelofibrosis Transplant Scoring System (MTSS).¹

Recently, a new scoring system, the Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI), has been identified to assess role of comorbidities and body mass index (BMI) in transplant prognostication for patients with MF. Here, we summarize a retrospective study by Polverelli N et al.¹

Study design¹

• Patients with MF who had not undergone transplant but were selected to undergo transplant in chronic phase were included in this study.
• Endpoints included overall survival (OS) and non-relapse mortality (NRM) in patients classed as low-, intermediate-, or high-risk according to the HCT-CI.

Key findings¹

• Overall, 4,086 patients with MF were included in the analysis, and 54% of patients with comorbidity data had ≥1 comorbidity.
  • Pulmonary conditions were most prevalent (12.7% were moderate, and 6.8% were severe).
  • Prevalence of massive splenomegaly was lower in high-risk vs intermediate- and low-risk patients (17% vs 22% and 28%, respectively).
• The 5-year NRM and OS rates were higher in patients assessed as high-risk compared with low-risk, according to the HCT-CI (Table 1).
  • This indicated that comorbidities continue to impact transplant outcomes and should be part of the transplant selection process alongside existing criteria.

Table 1. 5-year survival rates in patients with low-, intermediate-, and high-risk patients with MF*

OS, overall survival; NRM, non-relapse mortality. *Adapted from Polverelli N, et al.1
Category, % (unless stated otherwise)	Low risk (0), n = 1,701	Intermediate risk (1,2), n = 762	High risk (≥3), n = 694
5-year NRM	27	33	36
5-year OS	58	52	46

• No significant differences were found across BMI groups and NRM, and OS (p = 0.5 and p = 0.3, respectively).
  • In this context, patients who are overweight and obese should not be excluded from transplant. However, this contrasts with findings from other studies, and further evaluation is needed to clarify the role of BMI in transplant outcomes.

Key learnings

HCT-CT is a prognostically significant assessment for patients with MF undergoing transplant and may increase understanding of risk factors and guiding decision-making in transplant considerations. BMI has little impact on transplant outcomes in this population, whilst comorbidities do impact outcomes. Future studies aiming to validate these findings and assessments could further enhance the evaluation for patients with MF undergoing transplant consideration, especially the integration of comorbidity assessments alongside existing scoring systems.