TY - JOUR
T1 - Prognostic risk models for transplant decision-making in myelofibrosis
AU - Hernández-Boluda, Juan Carlos
AU - Pereira, Arturo
AU - Correa, Juan Gonzalo
AU - Alvarez-Larrán, Alberto
AU - Ferrer-Marín, Francisca
AU - Raya, José María
AU - Martínez-López, Joaquín
AU - Velez, Patricia
AU - Pérez-Encinas, Manuel
AU - Estrada, Natalia
AU - García-Gutiérrez, Valentín
AU - Fox, María Laura
AU - Payer, Angel
AU - Kerguelen, Ana
AU - Cuevas, Beatriz
AU - Durán, María Antonia
AU - Ramírez, María José
AU - Gómez-Casares, María Teresa
AU - Mata-Vázquez, María Isabel
AU - Mora, Elvira
AU - Gómez, Montse
AU - Cervantes, Francisco
PY - 2018/5/1
Y1 - 2018/5/1
N2 - © 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Prognostic models are widely used in clinical practice for transplant decision-making in myelofibrosis (MF). We have compared the performance of the International Prognostic Scoring System (IPSS), dynamic IPSS (DIPSS), and DIPSS-plus in a series of 544 patients with primary or secondary MF aged ≤ 70 years at the time of diagnosis. The median projected survival of the overall series was 9.46 years (95% confidence interval 7.44–10.59). Median survival for the highest risk groups was less than 4 years in the three prognostic models. By contrast, the projected survival for patients in the intermediate-2 categories by the IPSS, DIPSS, and DIPSS-plus was 6.6, 5.6, and 6.5 years, respectively. The number of patients in the intermediate-2 and high-risk categories was smaller in the DIPSS than in the IPSS or the DIPSS-plus. The IPSS and DIPSS-plus were the best models to discriminate between the intermediate-1 and intermediate-2 risk categories, which is a critical cut-off point for patient selection to transplant. Among patients assigned at diagnosis to the intermediate-2 or high-risk groups by the IPSS, DIPSS, and DIPSS-plus, only 17, 21, and 20%, respectively, were subsequently transplanted. In conclusion, in our contemporary series of younger MF patients only the highest risk categories of the current prognostication systems have a median survival below the 5-year threshold recommended for considering transplantation. Patient selection for transplantation can significantly differ depending on which prognostication model is used for disease risk stratification.
AB - © 2018, Springer-Verlag GmbH Germany, part of Springer Nature. Prognostic models are widely used in clinical practice for transplant decision-making in myelofibrosis (MF). We have compared the performance of the International Prognostic Scoring System (IPSS), dynamic IPSS (DIPSS), and DIPSS-plus in a series of 544 patients with primary or secondary MF aged ≤ 70 years at the time of diagnosis. The median projected survival of the overall series was 9.46 years (95% confidence interval 7.44–10.59). Median survival for the highest risk groups was less than 4 years in the three prognostic models. By contrast, the projected survival for patients in the intermediate-2 categories by the IPSS, DIPSS, and DIPSS-plus was 6.6, 5.6, and 6.5 years, respectively. The number of patients in the intermediate-2 and high-risk categories was smaller in the DIPSS than in the IPSS or the DIPSS-plus. The IPSS and DIPSS-plus were the best models to discriminate between the intermediate-1 and intermediate-2 risk categories, which is a critical cut-off point for patient selection to transplant. Among patients assigned at diagnosis to the intermediate-2 or high-risk groups by the IPSS, DIPSS, and DIPSS-plus, only 17, 21, and 20%, respectively, were subsequently transplanted. In conclusion, in our contemporary series of younger MF patients only the highest risk categories of the current prognostication systems have a median survival below the 5-year threshold recommended for considering transplantation. Patient selection for transplantation can significantly differ depending on which prognostication model is used for disease risk stratification.
KW - Myelofibrosis
KW - Prognostic models
KW - Risk factors
KW - Survival
KW - Transplantation
U2 - 10.1007/s00277-018-3240-x
DO - 10.1007/s00277-018-3240-x
M3 - Article
VL - 97
SP - 813
EP - 820
JO - Annals of Hematology
JF - Annals of Hematology
SN - 0939-5555
IS - 5
ER -