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Is allogeneic stem cell transplantation for myelofibrosis still indicated at the time of molecular markers and JAK inhibitors era?
Author(s) -
Lestang Elsa,
Peterlin Pierre,
Le Bris Yannick,
Dubruille Viviane,
Delaunay Jacques,
Godon Catherine,
Theisen Olivier,
Blin Nicolas,
Mahe Beatrice,
Gastinne Thomas,
Garnier Alice,
Touzeau Cyrille,
Voldoire Maud,
Bene Marie C.,
Le Gouill Steven,
Milpied Noel,
Mohty Mohamad,
Moreau Philippe,
Guillaume Thierry,
Chevallier Patrice
Publication year - 2017
Publication title -
european journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 84
eISSN - 1600-0609
pISSN - 0902-4441
DOI - 10.1111/ejh.12891
Subject(s) - myelofibrosis , medicine , international prognostic scoring system , ruxolitinib , univariate analysis , transplantation , autologous stem cell transplantation , oncology , stem cell , overall survival , gastroenterology , myeloid leukemia , hematopoietic stem cell transplantation , myelodysplastic syndromes , multivariate analysis , surgery , bone marrow , biology , genetics
Objective The role of allogenic stem cell transplantation ( ASCT ) is still debated in myelofibrosis (MF). Methods A retrospective analyzed was performed to compare the outcome of 71 patients with intermediate‐2 or high‐risk Dynamic International Prognosis Scoring System+ ( DIPSS +) primary ( PMF ) or secondary ( SMF ) myelofibrosis with an indication of ASCT as they ultimately underwent the procedure (n=34) or not (n=37). Results Five‐year overall survival ( OS ) was not statistically different between both groups (allograft: 52% vs no allograft: 34%, P =.12). However, progression to myelodysplastic syndrome or acute myeloid leukemia at 5 years was significantly lower in transplanted patients (14% vs 50%, P =.01). In univariate analysis, 5‐year OS was significantly higher for transplanted vs non‐transplanted patients with unfavorable karyotype (75% vs 0%, P =.001), SMF (71% vs 20%, P =.001) or high DIPSS + score (46% vs 15%, P =.03). There was also a trend for better 5‐year OS in allografted patients with high JAK 2 V617F burden (>65%) (75% vs 8%, P =.07). Interestingly, the survival of patients who did not proceed to ASCT was dramatically increased by the use of ruxolitinib. Conclusions Not all intermediate‐2/high‐risk DIPSS + MF patients benefit from ASCT , especially since the introduction of JAK 2 inhibitors.