Delayed Transplant Yields Better PMF Outcomes Following Ruxolitinib Failure

In patients with primary myelofibrosis (PMF) in whom ruxolitinib therapy has failed, delayed allogeneic hematopoietic stem cell transplant (HSCT) has better outcomes. This finding is according to a Markov model analysis recently published in Haematologica.

“The optimal timing of allogeneic [HSCT] remains to be elucidated in the ruxolitinib era,” the model’s authors wrote regarding the current need for such an analysis.

They constructed a model that simulated a five-year clinical course for patients with PMF who were candidates for allogeneic HSCT and in whom ruxolitinib therapy was unsuccessful. The researchers compared outcomes in patients who underwent transplant immediately after ruxolitinib failure with those for whom transplant was delayed. Further subgroup analysis was used to compare outcomes in patients aged younger than 60 years with those in patients aged 60 years or older.

Across all patient ages in the model, patients’ expected life-years were longer if transplant was delayed after ruxolitinib failure rather than performed immediately.

When calculating quality-adjusted life-years (QALYs), baseline analysis found that delaying transplant after ruxolitinib failure was superior to immediate transplant, producing 2.26 QALYs versus 2.19 QALYs, respectively. Among patients aged 60 years or older, delaying transplant again showed superiority to immediate transplant, producing 2.21 QALYs versus 1.98 QALYs, respectively.

Among patients aged younger than 60 years, delayed transplant and immediate transplant brought matching QALY results, with each producing 2.31 QALYs.

The authors performed a one-way sensitivity analysis and found that the most influential parameter for QALYs was the utility of being alive without chronic graft-versus-host disease after immediate allogeneic HSCT.

“A value higher than 0.836 could reverse the superiority of delayed [HSCT] after ruxolitinib failure,” the authors noted.

They concluded that delayed transplant is superior to immediate transplant after ruxolitinib failure in patients with PMF aged 60 years or older “and is also a promising strategy even in those aged [younger than] 60.”

Reference

Okada Y, Nakasone H, Kawamura S, et al. Decision analysis for transplant candidates with primary myelofibrosis in the ruxolitinib era. Haematologica. 2024. doi:10.3324/haematol.2024.285256