What Are Potential Barriers to HSCT in Myelofibrosis?

Although patients with myelofibrosis (MF) are under-referred and under-transplanted, those with splenomegaly are more likely to be referred for allogeneic hematopoietic stem cell transplant (HSCT), according to a recent study.

The study was led by Serena Tharakan, MD, of the Icahn School of Medicine at Mount Sinai, and presented at the Twelfth Annual Meeting of the Society of Hematologic Oncology. Dr. Tharakan and colleagues “aimed to better understand referral patterns and potential barriers to HSCT in MF patients.” The primary endpoints were referral to HSCT and receipt of HSCT, and the mean follow-up was 5.8 years.

A total of 208 transplant-eligible patients were included in the retrospective analysis. Of those, 144 (69%) were referred to HSCT and 64 (31%) were transplanted. Palpable splenomegaly (odds ratio [OR]: 2.39 [1.18, 4.96], P=0.017) and age were the most significant factors that predicted referral for HSCT, according to a multivariate analysis. The likelihood of HSCT referral reduced by 5% for each year older at diagnosis. The association between splenomegaly and referral for HSCT “may reflect the more advanced nature of their disease,” the researchers noted.

Peripheral blood blast percentage and donor type were predictive of HSCT receipt in patients who were referred. Transplanted patients had a median 0% peripheral blasts, whereas patients who were referred but not transplanted had a median 2% blasts (P=0.02).

Donor type also impacted the likelihood of HSCT. Patients with related donors were less likely to be transplanted than patients with unrelated donors (OR: 0.22 [0.05, 0.76], P=0.023).

There was no association between risk scores and likelihood of referral or HSCT. Age was also a significant factor predictive of referral to HSCT, as older patients are less likely to be referred to transplant.

Reference

Tharakan S, Sastow D, van Hyfte G, et al. Allogeneic stem cell transplant in myelofibrosis patients: a real-world analysis. Abstract #MPN-452. Presented at the Twelfth Annual Meeting of the Society of Hematologic Oncology. September 4-7, 2024; Houston, Texas.