The only curative treatment for myelofibrosis (MF) continues to be allogeneic hematopoietic stem cell transplant (HSCT). Occasionally, adverse events posttransplantation can occur and usually present within the first 2 years after posttransplant. Researchers recently sought to analyze the outcome of 2-year disease-free survivors in a systematic review
published in Haematologica.
In total 2459 patients were identified through the Human Mortality Database who had received a first HSCT between January 1995 and December 2014 for primary or secondary MF. Of this, 1055 patients had been reported alive and disease free 2 years after HSCT.
The entire cohort (N = 2459) had an overall survival rate at 10 years of 41% (95% CI: 39-44) and a disease-free survival rate of 32% (95% CI: 30-35). In the 1055 patients who were categorized as “long-term survivors,” 166 deaths were reported within 10 years after HSCT. For all time periods, the most common cause of death was relapse of MF, followed by graft versus host disease, and infection. Of note, infection was most common between 2- and 5-years posttransplant. This high risk of infection “should be taken into account in long-term monitoring strategies and highlights the importance of appropriate anti-infective prophylaxis,” wrote the authors.
Furthermore, secondary cancers occurred in 34 patients before reaching 2 years after HSCT, and 87 patients after 2 years. The most frequent cancer was solid tumor, acute leukemia or myelodysplastic syndrome, and lymphoma.
Overall, the authors found that results show the survival rate 10 years after transplantation in these 2-year survivors is 74%. Patients with MF that reach the 2-year mark post-HSCT, particularly younger and female patients, have “good survival,” according to study authors. The investigators recommended that patients should receive follow up for life, and particularly, severe late complications and late relapses should be monitored in order to reduce life-threatening complications.
Robin M, de Weede LC, Wolschke C, et al. Long-term outcome after allogeneic hematopoietic cell transplantation for myelofibrosis [published online February 2019]. Haematol.