Transplant in patients MF: the next best approach after matched donor allo-HSCT

Allogeneic hematopoietic stem cell transplant (allo-HSCT) is currently the only curative treatment option for patients with myelofibrosis (MF). In the absence of a human leukocyte antigen (HLA)-matched donor, cord blood transplant (CBT) or HLA-haploidentical transplant (haplo-HSCT) provide other options for these patients – although the best of these options remains unclear.¹

Here, we summarize a retrospective study by Sakatoku et al.¹ published in Nature on February 20, 2024, comparing CBT and haplo-HSCT as alternative transplant options for MF.

Study design¹

• This multicenter study analyzed patient data from the Japanese Society for Transplantation and Cellular Therapy between 2003 and 2019.
• Patients were undergoing HSCT for the first time to treat MF.

Key findings¹

• Overall, 77 patients with MF were included, with 27 undergoing haplo-HSCT and 50 undergoing CBT.
• The median age was 59 years, and conditioning intensity before transplant was similar in both groups.
• More patients were male than female in both groups (78% and 70%, respectively).
• Most patients had not been treated by a Janus kinase inhibitor prior to transplant in both groups (59% and 74%, respectively).

Results¹

• The median time to neutrophil recovery was longer in CBT recipients compared with haplo-HSCT recipients (27 vs 17 days).
  
• However, final neutrophil engraftment and survival responses were comparable between groups (Figure 1).

Figure 1. Neutrophil engraftment and survival responses in patients with MF who received haplo-HSCT compared with CBT* 

CBT, cord blood transplant; CI, cumulative incidence, GvHD, graft-versus-host disease; HSCT, hematopoietic stem cell transplant; MF, myelofibrosis; NRM, non-relapse mortality; OS; overall survival. 
*Adapted from Sakatoku K, et al.¹. 
†Defined as the patient being alive at 28 days with an absolute neutrophil count <0.5 × 109/L. 
‡After 3 years. 

• Other studies report similar findings, as captured in a recent report from the European Society for Blood and Marrow Transplantation.