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ASH 2024 | Personalized transplant decision-making for patients with myelofibrosis
Francesco Passamonti, MD, University of Milan, Milan, Italy, comments on the value of personalized transplant decision-making for myelofibrosis in the era of molecular genetics and JAK inhibition. Prof. Passamonti highlights the need to balance the risk of mortality due to stem cell transplant with the risk of disease progression, and suggests that a multi-state model for statistical analysis can help in making informed decisions about when to proceed with stem cell transplantation. This interview took place at the 66th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (AI-generated)
This is an important paper in my view because for the time being we use for the stem cell transplant decision some prognostic model that can identify patients at high risk on the basis of the natural history of disease. And we use IPSS, DIPSS, MIPS70, MIPS70 version 2 plus. And all these parameters of these models can help us identify those patients at high risk of mortality. So today we decide stem cell transplantation for patients with higher risk group within these three, four models...
This is an important paper in my view because for the time being we use for the stem cell transplant decision some prognostic model that can identify patients at high risk on the basis of the natural history of disease. And we use IPSS, DIPSS, MIPS70, MIPS70 version 2 plus. And all these parameters of these models can help us identify those patients at high risk of mortality. So today we decide stem cell transplantation for patients with higher risk group within these three, four models. And then we also apply the MTSS score model that can predict survival after stem cell transplant. So there is a combo of patients at high risk for the disease and lower risk for mortality after stem cell transplantation. The question for research is when to transfer a patient within these conditions. For doing this together with Nico Gagelmann, we decided to take a big huge number of patients, carrying patients from different cohorts, the MYSEC-PM for the secondary myelofibrosis and another big cohort, the ruxo cohort, that was developed mainly in Italy. So doing this we have a practically patient receiving ruxolitinib that is the standard of treatment today so the situation is within the context of contemporary treatment. And so the aim is to define the timing as I said and we found that we have to proceed with stem cell transplantation earlier in those patients with a higher risk disease and the lower risk MTSS. We can delay stem cell transplant in those patients with the lower risk disease and lower risk MTSS. This is a balance, okay? When you have different patients with higher risk MTSS and higher risk myelofibrosis, you can probably delay because the risk of mortality due to stem cell transplant is too high. So I basically think that this can help us in the future managing of patients with myelofibrosis, according to this new multi-state model for statistical analysis. That is a statistical analysis that they take into consideration that the patient can change his state or the state of the disease over time.
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Disclosures
Novartis: Honoraria, Membership on an entity’s Board of Directors or advisory committees.
