A study published in Transplant and Cellular Therapy assessed outcomes in patients with myelofibrosis (MF) who choose to under hematopoietic cell transplant (HCT) versus non-transplant therapies. They found that white patients were more likely to identify a well-matched donor. There was no survival difference between upfront HCT versus non-transplant therapy; however, more patients in the HCT arm were in remission at last follow-up.
Researchers sought to identify patient, disease, and donor-related factors that influence HCT decisions in patients with MF, as well as compare survival in patients who elect upfront HCT versus non-transplant therapy.
The retrospective chart review included 183 patients aged younger than 70 years. Of this cohort, 129 (70%) developed an HCT indication. Age >60 years was significantly associated with higher rates of human leukocyte antigen (HLA)-typing refusal (n=13/72 vs. n=1/44; P=0.02). White patients had an increased rate of identifying well-matched donors compared with non-white patients (75% vs. 48%; P=0.02).
Among the 102 patients who were HLA typed, 93% found a potential donor. Sixty-nine patients (68%) found a well-matched donor, and 25 (25%) found a mismatched donor/haplo-identical related; the remaining eight patients (8%) found no donor. Among the 69 patients with well-matched donors, 34 (49%) did not pursue upfront HCT despite an indication for transplant. Despite availability of a well-matched donor, a significant proportion of patients with MF who had a transplant indication did not pursue HCT.
After a median follow-up of 3.2 years (range, 0.5-8.0 years), the researchers observed no difference in survival between patients who underwent upfront HCT versus those who received non-transplant therapies, although more patients were in remission in the HCT arm at the last follow-up.
“These findings emphasize the importance of patient education when discussing HCT in MF, as well as emphasizing individual goals of care, particularly within older-age patients,” the researchers concluded.