TCI score for prediction of allo-HSCT outcomes in myelofibrosis

Results from a multicenter European Society for Blood and Marrow Transplantation (EBMT) registry study, involving 2,454 patients with myelofibrosis (MF) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) between 2012 and 2021, were published by Sobieralski et al. in Bone Marrow Transplantation. The study explored the association between the transplant conditioning intensity (TCI) score and transplant outcomes.

Key data: Patients receiving TCI-intermediate/high intensity regimens had similar overall survival (hazard ratio [HR], 1.12; 95% confidence interval [CI], 0.97–1.30) and progression-free survival (HR 1.00; 95% CI, 0.88–1.14) compared with TCI-low regimens. However, TCI-intermediate/high regimens were associated with lower cumulative incidence of relapse (HR, 0.74; 95% CI, 0.61–0.91; p = 0.008) and higher non-relapse mortality (NRM; HR, 1.24; 95% CI, 1.04–1.48; p = 0.02).

Key learning: While higher intensity TCI regimens are associated with lower relapse incidence, this benefit is offset by increased NRM, resulting in no overall survival advantage. However, the TCI index may enable a personalized approach to conditioning regimen selection by balancing relapse risk with patient frailty.