Allogeneic stem cell transplantation for myelofibrosis patients aged ≥65 years

Abstract

Introduction Myelofibrosis (MF) is a disease of elderly with median age of 65 years at diagnosis. Allogeneic stem cell transplantation (ASCT) currently is the only potentially curative option, although associated with treatment‐related morbidity and mortality. Development of reduced intensity conditioning (RIC) regimens enabled transplant to be performed successfully in older patients. Objectives and Methods To evaluate outcome of transplantation among elderly patients (≥65 years), we conducted retrospective analysis of results in 45 patients transplanted between 2002 and 2018 at the University Medical Center Hamburg. Median age at ASCT was 67 years (r: 65‐74). The majority of patients (n = 43) received busulfan plus fludarabine RIC regimen and were classified as DIPSS intermediate‐2 or high risk at time of transplantation. Results After a median follow‐up of 4 years, 6‐year estimated progression‐free survival and overall survival were 60% and 64%, respectively. Cumulative incidence of non‐relapse mortality was 21% at 1 year. Cumulative incidence of relapse at 6 years was 10%. Patients with Sorror score 3 or less had a significant better survival (73% vs 25%, P = .009). Conclusion Reduced intensity conditioning regimen followed by ASCT in older patients with myelofibrosis is a curative treatment option. Outcome is more favorable in patients with no or minimal comorbidities.

2021 Update on allogeneic hematopoietic stem cell transplant for myelofibrosis: A review of current data and applications on risk stratification and management

“…Over the last couple of decades use of reduced‐intensity conditioning (RIC) has improved access to patients to this life‐saving and curative procedure. Kroger et al reported in patients with a median age of 67 years (65–74 years) outcome was comparable to other reports with 6 years estimated progression‐free survival and OS of 60% and 64%; one‐year NRM was 21% 8 . This study predominantly included fludarabine and busulfan (FB) RIC.…”

“…Kroger et al reported in patients with a median age of 67 years (65–74 years) outcome was comparable to other reports with 6 years estimated progression‐free survival and OS of 60% and 64%; one‐year NRM was 21%. 8 This study predominantly included fludarabine and busulfan (FB) RIC. Another study using melphalan based conditioning regimen in patients > 70, included 53 patients with any diagnosis including six MF patients: after 31 months follow up 2‐year OS, PFS, NRM was respectively 69%, 64%, and 17%.…”

Allogeneic hematopoietic cell transplantation in older myelofibrosis patients: A study of the chronic malignancies working party of EBMT and the Spanish Myelofibrosis Registry

“…3,4 There is an increasing use of allo-HCT in older patients with hematological malignancies, which has yielded reasonable results. 5,6 Regarding MF, two small retrospective series from academic centers 7,8 have shown favorable allo-HCT outcomes in elderly MF patients, particularly in those with minor comorbidities. 8 These studies have demonstrated the feasibility of the procedure in selected older adults with MF, but a comparison of allo-HCT results with nontransplant approaches is lacking in this age group.…”

Splenic irradiation for myelofibrosis prior to hematopoietic cell transplantation: A global collaborative analysis

“…These results may caution the application of higher-intensity treatment in such a vulnerable population with severe disease burden and frailty, irrespective of age. 37,38 We acknowledge several limitations, which are mainly due to the retrospective nature of our study. We cannot fully exclude the selection bias of patients receiving splenic irradiation.…”