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Prognostic risk models for transplant decision-making in myelofibrosis

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Abstract

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.

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Acknowledgments

This work was supported by the grant RD12/0036/0010 from the Instituto de Salud Carlos III, Spanish Ministry of Health. We are indebted to all members of GEMFIN participating in the Spanish Registry of Myelofibrosis.

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Authors and Affiliations

  1. Hematology Department, Hospital Clínico Universitario, INCLIVA, Avd. Blasco Ibáñez 17, 46010, Valencia, Spain

    Juan-Carlos Hernández-Boluda & Montse Gómez

  2. Hemotherapy and Hemostasis Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain

    Arturo Pereira

  3. Hematology Department, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain

    Juan-Gonzalo Correa & Francisco Cervantes

  4. Hematology Department, Hospital del Mar-IMIM, Barcelona, Spain

    Alberto Alvarez-Larrán

  5. Hematology and Medical Oncology Department, Hospital Morales Meseguer-CIBERER, IMIB-Arrixaca, UCAM, Murcia, Spain

    Francisca Ferrer-Marín

  6. Hematology Department, Hospital Universitario de Canarias, Tenerife, Spain

    José-María Raya

  7. Hematology Department, Hospital 12 de Octubre, Madrid, Spain

    Joaquín Martínez-López

  8. Hematology Department, Institut Català d’Oncologia, Hospital Duran i Reynals, Hospitalet de Llobregat, Barcelona, Spain

    Patricia Velez

  9. Hematology Department, Hospital Clínico Universitario, Santiago de Compostela, Spain

    Manuel Pérez-Encinas

  10. Hematology Department, Institut Català d’Oncologia–Hospital Germans Trias i Pujol, Josep Carreras Leukemia Research Institute, Autonomous University of Barcelona, Badalona, Spain

    Natalia Estrada

  11. Hematology Department, Hospital Ramón y Cajal, Madrid, Spain

    Valentín García-Gutiérrez

  12. Hematology Department, Hospital Vall d’Hebron, Barcelona, Spain

    María-Laura Fox

  13. Hematology Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    Angel Payer

  14. Hematology Department, Hospital La Paz, Madrid, Spain

    Ana Kerguelen

  15. Hematology Department, Hospital Universitario de Burgos, Burgos, Spain

    Beatriz Cuevas

  16. Hematology Department, Hospital Son Espases, Mallorca, Spain

    María-Antonia Durán

  17. Hematology Department, Hospital de Jerez, Cádiz, Spain

    María-José Ramírez

  18. Hematology Department, Hospital Dr Negrín, Las Palmas de Gran Canaria, Spain

    María-Teresa Gómez-Casares

  19. Hematology Department, Hospital Costa del Sol, Marbella, Spain

    María-Isabel Mata-Vázquez

  20. Hematology Department, Hospital La Fe, IIS La Fe, Valencia, Spain

    Elvira Mora

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  1. Juan-Carlos Hernández-Boluda
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  2. Arturo Pereira
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Corresponding author

Correspondence to Juan-Carlos Hernández-Boluda.

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The authors declare that they have no conflict of interest.

Authorship and disclosures

JCHB designed the research, performed the statistical analysis, interpreted the results, and wrote the manuscript. APe performed the statistical analysis, interpreted the results, and wrote the manuscript. JGC, AAL, FFM, JMR, JML, PV, MPE, NE, VGG, MLF, APa, AK, BC, MAD, MJR, MTGC, MIMV, EM, and MG collected the data, revised the manuscript, and approved the final version of the manuscript. FC interpreted the results and wrote the manuscript.

The authors declare that they have no conflict of interest.

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Hernández-Boluda, JC., Pereira, A., Correa, JG. et al. Prognostic risk models for transplant decision-making in myelofibrosis. Ann Hematol 97, 813–820 (2018). https://doi.org/10.1007/s00277-018-3240-x

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