EBMT 2022 | Outcomes of patients with accelerated-phase myelofibrosis after reduced-intensity HSCT
Nico Gagelmann, MD, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, gives an overview of the results of a study investigating the outcomes of patients with accelerated-phase (AP) myelofibrosis (MF) following reduced-intensity hematopoietic stem cell transplantation (HSCT). After a median follow-up of six years, the study did not report significant differences in overall survival (OS) and relapse-free survival (RFS) between patients with AP MF and patients with chronic phase (CP) MF. Nevertheless, the study identified a trend towards a higher relapse risk in patients with AP MF. In addition, it was found that patients with AP MF have a higher count of circulating and bone marrow blasts. However, Dr Gagelmann explains that one needs to be cautious when interpreting these results as it is difficult to measure blasts in the bone marrow of patients with MF. This interview took place at the 48th Annual Meeting of the European Group for Blood and Marrow Transplantation (EBMT) 2022, which was held virtually.
Transcript (edited for clarity)
Accelerated myelofibrosis currently defined by the circulating blasts 10% to 19%, and usually confers a very high risk for progression and poor outcome, especially from diagnosis. However, the outcome of hematopoietic stem cell transplantation for these patients with accelerated myelofibrosis has not been published yet, so far. And we analyze the outcome of, about, 350 patients with clinical and genetic information, with primary or secondary myelofibrosis of whom we identified 35 with accelerated-phase myelofibrosis...
Accelerated myelofibrosis currently defined by the circulating blasts 10% to 19%, and usually confers a very high risk for progression and poor outcome, especially from diagnosis. However, the outcome of hematopoietic stem cell transplantation for these patients with accelerated myelofibrosis has not been published yet, so far. And we analyze the outcome of, about, 350 patients with clinical and genetic information, with primary or secondary myelofibrosis of whom we identified 35 with accelerated-phase myelofibrosis.
And in comparison with what we call chronic phase myelofibrosis, so blasts less than 10%, the accelerated phase had a higher count of leukocytes, but also slightly lower count of hemoglobin and more constitutional symptoms. And after a median follow up of six years, we identified no significant difference in outcome of overall survival for chronic phase and accelerated-phase myelofibrosis, but also no difference in relapse-free survival. However, there was a trend towards higher relapse risk for patients with accelerated myelofibrosis. And this was also confirmed in multivariate and continuous analyses using spline analysis.
We then did a short sub-analysis comparing circulating blasts and bone marrow blasts. And in myelofibrosis bone marrow blasts are very difficult to measure because the patients have fibrosis in their bone marrow. And therefore many bone marrow biopsies are very frustrating. And we found that, obviously, patients with accelerated phase of myelofibrosis with higher circulating blasts also had higher bone marrow blasts. But, these results need to be interpreted with a bit of caution because we identified only 80 patients with a valuable bone marrow biopsies.
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