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

Panpan Zhu; Xiaoyu Lai; Lizhen Liu; Jimin Shi; Jian Yu; Yanmin Zhao; Luxin Yang; Tingting Yang; Weiyan Zheng; Jie Sun; Wenjun Wu; Yi Zhao; Zhen Cai; He Huang; Yi Luo

doi:10.1186/s12967-024-05080-3

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

J Transl Med. 2024 Mar 13;22(1):275. doi: 10.1186/s12967-024-05080-3.

Authors

Panpan Zhu^{1

2

3}, Xiaoyu Lai^{1

2

3}, Lizhen Liu^{1

2

3}, Jimin Shi^{1

2

3}, Jian Yu^{1

2

3}, Yanmin Zhao^{1

2

3}, Luxin Yang^{1

2

3}, Tingting Yang^{1

2

3}, Weiyan Zheng^{1

2

3}, Jie Sun^{1

2

3}, Wenjun Wu^{1

2

3}, Yi Zhao^{1

2

3}, Zhen Cai^{1

2

3}, He Huang^{4

5

6}, Yi Luo^{7

8

9}

Affiliations

¹ Bone Marrow Transplantation Center of The First Affiliated Hospital & Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, 311121, China.
² Institute of Hematology, Zhejiang University, Hangzhou, 311121, China.
³ Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, 311121, China.
⁴ Bone Marrow Transplantation Center of The First Affiliated Hospital & Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, 311121, China. huanghe@zju.edu.cn.
⁵ Institute of Hematology, Zhejiang University, Hangzhou, 311121, China. huanghe@zju.edu.cn.
⁶ Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, 311121, China. huanghe@zju.edu.cn.
⁷ Bone Marrow Transplantation Center of The First Affiliated Hospital & Liangzhu Laboratory, Zhejiang University School of Medicine, Hangzhou, 311121, China. luoyijr@zju.edu.cn.
⁸ Institute of Hematology, Zhejiang University, Hangzhou, 311121, China. luoyijr@zju.edu.cn.
⁹ Zhejiang Province Engineering Laboratory for Stem Cell and Immunity Therapy, Hangzhou, 311121, China. luoyijr@zju.edu.cn.

Abstract

Background: The prognostic significance of myelofibrosis (MF) grade in patients with myelodysplastic syndrome (MDS) following an allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains elusive.

Methods: We retrospectively analyzed data from 153 patients with MDS who underwent allo-HSCT and divided the patients into the MF-0/1 (N = 119) and MF-2/3 (N = 34) cohorts to explore the impact of MF on outcomes of allo-HSCT.

Results: The 2-year rates of relapse, non-relapse mortality (NRM), overall survival (OS), and progression-free survival (PFS) were 10.9% (95% confidence interval [CI] 5.9%-17.7%), 16.3% (95% CI 10.2%-23.6%), 76.6% (95% CI 69.0%-85.1%), and 72.8% (95% CI 65.0%-81.5%) in the MF-0/1 cohort, and 16.9% (95% CI 5.8%-32.9%), 14.7% (95% CI 5.3%-28.7%), 71.8% (95% CI 57.6%-89.6%), and 68.4% (95% CI 53.6%-87.2%) in the MF-2/3 cohort, respectively. No significant difference in the outcomes of allo-HSCT was observed between the two cohorts. Both univariate and multivariate analyses confirmed that MF-2/3 in patients with MDS had no effect on the prognosis of transplantation. In addition, major/bidirectional ABO blood type between donors and recipients was an independent risk factor for OS (hazard ratio [HR], 2.55; 95% CI 1.25-5.21; P = 0.010) and PFS (HR, 2.21; 95% CI 1.10-4.42; P = 0.025) in the multivariate analysis. In the subgroup of patients diagnosed with MDS with increased blasts (MDS-IB), it was consistently demonstrated that the clinical outcomes of the MF-2/3 cohort were comparable with those of the MF-0/1 cohort. The risk factors for OS and PFS in patients with MDS-IB were non-complete remission at transplantation and major/bidirectional ABO blood type.

Conclusions: In conclusion, MF grade had no significant effect on prognosis of allo-HSCT in patients diagnosed with MDS. Major/bidirectional ABO blood type should be carefully considered in the context of more than one available donor.

Keywords: Hematopoietic stem cell transplantation; Myelodysplastic syndromes; Myelofibrosis.

MeSH terms

Hematopoietic Stem Cell Transplantation*
Humans
Myelodysplastic Syndromes* / therapy
Primary Myelofibrosis* / complications
Primary Myelofibrosis* / therapy
Retrospective Studies
Transplantation, Homologous

Grants and funding

82170205/National Natural Science Foundation of China