Clinical Factors That Impact Allo-HCT Success in Patients With Myelofibrosis Older Than 70 Years

Patients with myelofibrosis (MF) older than 70 years who received allogeneic hematopoietic stem cell transplants (allo-HSCTs) had worse outcomes if they were of Hispanic ethnicity or they received transplants from mismatched unrelated donors (MMUDs). These findings highlight the importance of selecting matched donors and thoroughly assessing patients when considering allo-HSCT for older adults with MF.

Allo-HSCT is the only curative treatment for MF; however, older adult patients often have poor prognosis with this treatment. This study aimed to identify specific clinical characteristics in patients with MF older than 70 years to determine which were associated with worse outcomes.¹

The investigators analyzed data from the P-5646 dataset, publicly available from the Center for International Blood and Marrow Transplant Research. This retrospective analysis included 51 patients with a median age of 71.8 years. The study involved univariate and multivariate Cox regression to determine hazard ratios (HRs) for overall survival (OS), disease-free survival (DFS), and graft-versus-host-disease–free relapse-free survival (GRFS) in various subgroups.

Overall, the cohort showed 2-year survival rates of 58.8% (OS), 30.6% (DFS), and 12.2% (GRFS). When multivariate analysis was used to analyze specific subgroups, Hispanic ethnicity emerged as a significant risk. Hispanic patients exhibited significantly lower overall survival (HR,13.67; 95% CI, 1.71–108.50; P=.01) and disease-free survival (HR, 14.38; 95% CI, 2.17–95.40; P=.006) compared with non-Hispanic individuals. Although MMUDs were linked to poorer OS, DFS, and GRFS in univariate analysis, multivariate analysis only confirmed a significant impact on OS (HR, 10.29; 95% CI, 1.25–84.99; P=.03). These trends emphasize the necessity for tailored approaches in managing older patients with MF undergoing allo-HSCT.

REFERENCE

Shahzad M, Amin MK, Ponvilawan B, et al. Outcomes of allogeneic hematopoietic stem cell transplantation in older patients aged over 70 years with myelofibrosis. Abstract #2172. Presented at the ASH Annual Meeting; December 7-10, 2024; San Diego, California.