A prognostic scoring system identified multiple factors associated with survival in patients with myelofibrosis who received an allogeneic hematopoietic stem cell transplant (HSCT).
Roni Tamari, MD, of Memorial Sloan Kettering Cancer Center and colleagues developed and validated the prognostic model using data from the Center for International Blood and Marrow Transplant Research (CIBMTR) and the European Society for Blood and Marrow Transplantation (EBMT) registries.
They used the CIBMTR registry to identify 623 patients who received allogeneic HSCT between 2000 and 2016 in the United States. The researchers used a Cox proportional-hazards multivariable model to identify factors associated with outcomes in the CIBMTR cohort.
Dr. Tamari and colleagues constructed the scoring model and selected prognostic variables based on the CIBMTR data and assigned weighted scores to the variables. A score of one to two points was defined as a low score, a score of three to four points was an intermediate score, and five points was a high score. The researchers validated the model on an external cohort of 623 patients from the EBMT registry.
The model showed that being aged 50 years or older (hazard ratio [HR], 1.39; 95% CI, 0.98-1.96) and receiving a transplant from a matched unrelated donor (HR, 1.29; 95% CI, 0.98-1.7) were associated with an increased hazard of death. Both of those factors were assigned a weight of one point in the prognostic system.
Having hemoglobin lower than 100g/L at time of transplant (HR, 1.63; 95% CI, 1.2-2.19) and having a mismatched unrelated donor (HR, 1.78; 95% CI, 1.25-2.52) were also associated with an increased hazard of death. The researchers assigned both of those factors a weight of two points in the system.
The three-year overall survival (OS) rate was 69% in patients with a low score, 51% in those with an intermediate score, and 34% in those with a high score (P<.001).
An increasing score predicted increased transplant-related mortality (P=.0017) but was not predictive of relapse (P=.12). The derived score was predictive for OS (P<.001) and transplant-related mortality (P=.002) but was not predictive for relapse (P=.17) in the EBMT cohort.
“The proposed system was prognostic of survival in two large cohorts, CIBMTR and EBMT, and can easily be applied by clinicians consulting patients with [myelofibrosis] on transplant outcomes,” Dr. Tamari and colleagues concluded.
Tamari R, McLornan DP, Ahn KW, et al. A simple prognostic system in myelofibrosis patients undergoing allogeneic stem cell transplant: a CIBMTR/EBMT analysis. Blood Adv. 2023. doi:10.1182/bloodadvances.2023009886