Prognostic risk models for transplant decision-making in myelofibrosis

Juan Carlos Hernández-Boluda, Arturo Pereira, Juan Gonzalo Correa, Alberto Alvarez-Larrán, Francisca Ferrer-Marín, José María Raya, Joaquín Martínez-López, Patricia Velez, Manuel Pérez-Encinas, Natalia Estrada, Valentín García-Gutiérrez, María Laura Fox, Angel Payer, Ana Kerguelen, Beatriz Cuevas, María Antonia Durán, María José Ramírez, María Teresa Gómez-Casares, María Isabel Mata-Vázquez, Elvira MoraMontse Gómez, Francisco Cervantes

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    5 Citations (Scopus)

    Abstract

    © 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.
    Original languageEnglish
    Pages (from-to)813-820
    JournalAnnals of Hematology
    Volume97
    Issue number5
    DOIs
    Publication statusPublished - 1 May 2018

    Keywords

    • Myelofibrosis
    • Prognostic models
    • Risk factors
    • Survival
    • Transplantation

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