Effect of pre-transplant JAK1/2 inhibitors and CD34 dose on transplant outcomes in myelofibrosis.
Sunu L CyriacShruti PremMaría Queralt SalasShiyi ChenZeyad Al-ShaibaniWilson LamArjun LawVikas GuptaFotios V MichelisDennis Dong Hwan KimJeffrey Howard LiptonRajat KumarJonas MattssonAuro ViswabandyaPublished in: European journal of haematology (2021)
Allogeneic hematopoeitic cell transplantation (allo-HCT) is the only curative treatment for myelofibrosis (MF). We evaluate the impact of various factors on survival outcomes post-transplant in MF. Data of 89 consecutive MF patients (primary 47%) who underwent allo-HCT between 2005 and 2018 was evaluated. Fifty-four percent patients had received JAK1/2 inhibitors (JAKi) pre-HCT. The median CD34 count was 7.1x106 cells/kg. Graft failure was seen in 10% of the patients. Grade 3-4 acute GVHD (aGVHD) and moderate/severe chronic graft versus host disease (cGVHD) occurred in 24% and 40% patients, respectively. Two-year overall survival (OS) and relapse free survival (RFS) were 51% and 43%, respectively. Cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) at 2 years were 11% and 46%, respectively. Higher CD34 cell dose (≤5 × 106 cells/kg vs 5-9 or ≥9 × 106 cells/kg) and lower pre-HCT ferritin (</=1000 ng/ml) were associated with better OS, RFS and lower NRM. Grade 3-4 aGVHD was associated with higher NRM. Use of pre-transplant JAKi was associated with lower incidence of grade 3-4 aGVHD. In summary, higher CD34 cell dose is associated with better allo-HCT outcomes in MF and pre-HCT JAKi use is associated with reduced risk of severe aGVHD. These two modifiable parameters should be considered during allo-HCT for MF.
Keyphrases
- end stage renal disease
- cell cycle arrest
- ejection fraction
- free survival
- chronic kidney disease
- newly diagnosed
- induced apoptosis
- peritoneal dialysis
- type diabetes
- machine learning
- single cell
- stem cells
- coronary artery disease
- risk factors
- adipose tissue
- cell proliferation
- endoplasmic reticulum stress
- skeletal muscle
- liver failure
- signaling pathway
- insulin resistance
- combination therapy
- smoking cessation
- rectal cancer
- pi k akt