Juan-Carlos Hernández-Boluda, Arturo Pereira, Nicolaus Kröger, Jan J. Cornelissen, Jürgen Finke, Dietrich W. Beelen, Moniek de Witte, Keith Wilson, Uwe Platzbecker, Henrik Sengeloev, Didier Blaise, Hermann Einsele, Katja Sockel, William H. Krüger, Stig Lenhoff, Adriano Salaroli, Hans Martin, Valentín García-Gutiérrez, Vicenzo Pavone, Alberto Alvarez-Larrán, José-María Raya, Nienke Zinger, Luuk Gras, Patrick Hayden, Tomasz Czerw, Donal P. McLornan, Ibrahim Yakoub-Agha
- Allogeneic hematopoietic cell transplantation (allo-HCT) is increasingly used in older myelofibrosis (MF) patients, but its risk/benefit ratio compared to non-transplant approaches has not been evaluated in this population. We analyzed the outcomes of allo-HCT in 556 MF patients aged ≥65 years from the EBMT registry, and determined the excess mortality over the matched general population of MF patients ≥65 years managed with allo-HCT (n = 556) or conventional drug treatment (n = 176). The non-transplant cohort included patients with intermediate-2 or high risk DIPSS from the Spanish Myelofibrosis Registry. After a median follow-up of 3.4 years, the estimated 5-year survival rate, non-relapse mortality (NRM), and relapse incidence after transplantation was 40%, 37%, and 25%, respectively. Busulfan-based conditioning was associated with decreased mortality (HR: 0.7, 95% CI: 0.5–0.9) whereas the recipient CMV+/donor CMV- combination (HR: 1.7, 95% CI: 1.2–2.4) and the JAK2 mutated genotype (HR: 1.9, 95% CI: 1.1–3.5) predicted higher mortality. Busulfan-based conditioning correlated with improved survival due to less NRM, despite its higher relapse rate when compared with melphalan-based regimens. Excess mortality was higher in transplanted patients than in the non-HCT cohort in the first year of follow-up (ratio: 1.93, 95% CI: 1.13–2.80), whereas the opposite occurred between the fourth and eighth follow-up years (ratio: 0.31, 95% CI: 0.18–0.53). Comparing the excess mortality of the two treatments, male patients seemed to benefit more than females from allo-HCT, mainly due to their worse prognosis with non-transplant approaches. These findings could potentially enhance counseling and treatment decision-making in elderly transplant-eligible MF patients.
MetadatenAuthor: | Juan-Carlos Hernández-BoludaORCiD, Arturo Pereira, Nicolaus KrögerORCiDGND, Jan J. Cornelissen, Jürgen FinkeORCiDGND, Dietrich W. BeelenORCiDGND, Moniek de WitteORCiD, Keith Wilson, Uwe PlatzbeckerORCiDGND, Henrik SengeloevORCiD, Didier BlaiseORCiD, Hermann EinseleORCiDGND, Katja SockelGND, William H. KrügerORCiDGND, Stig Lenhoff, Adriano Salaroli, Hans MartinORCiD, Valentín García-GutiérrezORCiD, Vicenzo Pavone, Alberto Alvarez-LarránORCiD, José-María Raya, Nienke Zinger, Luuk Gras, Patrick HaydenORCiD, Tomasz CzerwORCiD, Donal P. McLornanORCiD, Ibrahim Yakoub-AghaORCiDGND |
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URN: | urn:nbn:de:hebis:30:3-639757 |
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DOI: | https://doi.org/10.1002/ajh.26279 |
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ISSN: | 1096-8652 |
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Parent Title (English): | American journal of hematology |
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Publisher: | Wiley-Liss |
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Place of publication: | New York, NY |
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Document Type: | Article |
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Language: | English |
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Date of Publication (online): | 2021/06/21 |
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Date of first Publication: | 2021/06/21 |
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Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
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Release Date: | 2022/12/30 |
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Volume: | 96 |
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Issue: | 10 |
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Page Number: | 9 |
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First Page: | 1186 |
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Last Page: | 1194 |
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Note: | The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions. |
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Institutes: | Medizin / Medizin |
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Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Sammlungen: | Universitätspublikationen |
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Licence (German): | Creative Commons - CC BY-NC-ND - Namensnennung - Nicht kommerziell - Keine Bearbeitungen 4.0 International |
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