Patients with myelofibrosis undergoing an allogeneic stem cell transplant (SCT), can be classified as low or high risk based on spleen size, transfusion history, and donor type (BMT 2010;45:458). In the present study we wished to validate this scoring system, based on a larger number of patients and longer follow up.
We have now analyzed 70 patients with myelofibrosis and a median age of 51, who underwent an allogeneic SCT in our Unit. The median follow up for surviving patients is 4.4 years (range 0.4–17 years). 33 patients had 0–1 unfavourable predictors (low risk) and 37 patients had 2 or more negative predictors (high risk).
The overall actuarial 10 year survival is 41%. In multivariate COX analysis independent unfavourable factors for survival were red blood cell (RBC) transfusions > 20 (RR 3,9; p=0,007), a spleen size >22 cm (RR 2,8; p=0.01) and an alternative donor (RR 3,4;p=0.001). Donor and patient age and gender, splenectomy and interval diagnosis transplant were not predictive.
The actuarial 10 year survival of patients with no risk factors (n=14), is 100%, with 1 risk factor (n=19) 47%, with 2 factors (n=27), 30%, and with 3 negative predictors (n=10) 0%.The actuarial 10 year survival of low risk (0–1 risk factors) and high risk patients (2–3 risk factors) is respectively 66% and 20%(p=0.0001): the difference is due both to a higher transplant related mortality for high risk patients (38% vs 9%, p=0.005) and a higher relapse related death (35% vs 21%; p=0.1). Peripheral blood CD34+ cell counts, pre-transplant, was a strong predictor of survival in univariate, but not in multivariate analysis.
Patients with myelofibrosis undergoing an allogeneic SCT, can be classified as low or high risk based on spleen size, transfusion history, and donor type. This scoring system may be useful to identify patients who would most benefit of the transplant procedure.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.