Allogeneic stem cell transplantation may overcome the adverse impact of myelofibrosis on the prognosis of myelodysplastic syndrome

Abstract

Purpose Myelofibrosis (MF) may serve as a poor prognostic factor in myelodysplastic syndromes (MDS). This study explored the impact of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on the outcome of MDS patients with MF. Patients and Methods Three hundred and sixteen MDS patients were enrolled in this retrospective study. Based on the degree of MF, we divided the patients into 2 groups: grade 0–1 (MF-0/1) and grade 2–3 (MF-2/3) groups. The clinical features, treatments, and prognosis in MDS patients with MF were analyzed. Results Forty-three (13.6%) patients were diagnosed as MF-2/3. Complex karyotypes were more common in the MF-2/3 compared to MF-0/1 groups (P = 0.002). The overall response rate (ORR) of cytoreduction was 49.0%, along with 53.3% in the MF-0/1 and 16.7% in MF-2/3 groups (P = 0.017). In total, 141 patients underwent allo-HSCT, including 121 in the MF-0/1 and 20 in MF-2/3 groups. The median time to neutrophil reconstruction was 12 (range: 7–34) and 14 (range: 10–45) days (P = 0.005), and platelet reconstruction was 14 (range: 8–68) and 18 (range: 8–65) days (P = 0.045) in the MF-0/1 and MF-2/3 groups, respectively. However, the cumulative incidence of neutrophil and platelet engraftment achieved at day + 30 was not different between the two groups (P = 0.107, P = 0.303, respectively). Non-relapse mortality, relapse, and acute and chronic graft-versus-host disease were similar between the two groups (all P > 0.05). Among patients with allo-HSCT, the 2-year overall survival (OS) was 68.5% (95% CI: 60.1–76.9%) and 68.4% (95% CI: 47.4–89.4%) in the MF-0/1 and MF-2/3 groups, respectively, (P = 0.636). Among patients without allo-HSCT, the 2-year OS was 49.9% (95% CI: 40.7–59.1%) and 19.2% (95% CI: 0–39.6%) in the MF-0/1 and MF-2/3 groups, respectively, (P = 0.002). In multivariate cox analysis, complex karyotype was an unfavorable factor for relapse (HR, 4.16; P = 0.006), disease-free survival (DFS) (HR, 2.16; P = 0.020), and OS (HR, 2.47; P = 0.009) post-transplantation. Conclusion Patients with MF-2/3 have more complex karyotypes and lower ORR of cytoreduction in MDS. Among patients without allo-HSCT, patients with MF-2/3 have a worse prognosis than those with MF-0/1. However, the adverse impact of MF on prognosis may be overcome by allo-HSCT.

Impact of myelofibrosis on patients with myelodysplastic syndromes following allogeneic hematopoietic stem cell transplantation

“…Previous reports have revealed that MF is associated with a higher rate of leukemia transformation [ 14 , 26 ], which may result in poor survival in patients with MDS. A previous study demonstrated that patients diagnosed with MDS concurrent with MF could achieve better survival in the allo-HSCT cohort than those without allo-HSCT [ 15 ]. In addition, they indicated no significant difference in survival between the MF-2/3 and MF-0/1 cohorts in allo-HSCT recipients.…”

“…However, a recent study revealed that allo-HSCT may overcome the detrimental impact of moderate-to-severe MF on prognosis in patients with MDS. A significantly superior survival was observed in the allo-HSCT cohort compared to those without allo-HSCT (2-year overall survival [OS] rate, 68.4% versus 19.2%) [ 15 ]. At the meanwhile, a few of studies indicated that the MF degree had no impact on prognosis of MDS in patients receiving allo-HSCT [ 16 , 17 ].…”

Histiocytoid giant cellulitis-like Sweet syndrome at the site of sternal aspiration: A case report and review of literature

“…MDS combined with myelofibrosis has a high risk of progression to acute leukemia or bone marrow failure, and the higher the fibrosis grade, the worse the prognosis[ 40 - 42 ]. Allogeneic hematopoietic stem cell transplantation may be able to overcome the poor prognosis associated with myelofibrosis[ 43 ]. For our patient, early skin biopsy may have led to a more timely diagnosis, and aggressive therapy may have improved his prognosis; however, the patient was unwilling to take such measures.…”

The impact of the donors’ COVID-19 status on the outcomes of allogeneic hematopoietic stem cell transplantation: a multi-center retrospective study

“…Engraftment, relapse, overall survival (OS), and disease-free survival (DFS) were assessed as previously described ( Zeng et al, 2021 ). Acute graft-versus-host disease (aGVHD) was defined according to the 1994 Consensus Conference on Acute GVHD Grading and graded from I to IV ( Przepiorka et al, 1995 ).…”