Prognostic risk models for transplant decision-making in myelofibrosis
Por:
Hernandez-Boluda, JC, Pereira, A, Correa, JG, Alvarez-Larran, A, Ferrer-Marin, F, Raya, JM, Martinez-Lopez, J, Velez, P, Perez-Encinas, M, Estrada, N, Garcia-Gutierrez, V, Fox, ML, Payer, A, Kerguelen, A, Cuevas, B, Duran, MA, Ramirez, MJ, Gomez-Casares, MT, Mata-Vazquez, MI, Mora, E, Gomez, M and Cervantes, F
Publicada:
1 may 2018
Resumen:
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.
Filiaciones:
Hernandez-Boluda, JC:
Hosp Clin Univ, INCLIVA, Dept Hematol, Avd Blasco Ibanez 17, Valencia 46010, Spain
Pereira, A:
Univ Barcelona, Hosp Clin, IDIBAPS, Hemotherapy & Hemostasis Dept, Barcelona, Spain
Correa, JG:
Univ Barcelona, Hosp Clin, IDIBAPS, Dept Hematol, Barcelona, Spain
Alvarez-Larran, A:
Hosp del Mar, IMIM, Dept Hematol, Barcelona, Spain
Ferrer-Marin, F:
UCAM, Hematol & Med Oncol Dept, Hosp Morales Meseguer, CIBERER,IMIB Arrixaca, Murcia, Spain
Raya, JM:
Hosp Univ Canarias, Dept Hematol, Tenerife, Spain
Martinez-Lopez, J:
Hosp 12 Octubre, Dept Hematol, Madrid, Spain
Velez, P:
Hosp Duran & Reynals, Inst Catala Oncol, Dept Hematol, Barcelona, Spain
Perez-Encinas, M:
Hosp Clin Univ, Dept Hematol, Santiago De Compostela, Spain
:
Autonomous Univ Barcelona, Dept Hematol, Josep Carreras Leukemia Res Inst, Inst Catala Oncol,Hosp Germans Trias & Pujol, Badalona, Spain
Garcia-Gutierrez, V:
Hosp Ramon & Cajal, Dept Hematol, Madrid, Spain
Fox, ML:
Hosp Valle De Hebron, Dept Hematol, Barcelona, Spain
Payer, A:
Hosp Univ Cent Asturias, Dept Hematol, Oviedo, Spain
Kerguelen, A:
Hosp La Paz, Dept Hematol, Madrid, Spain
Cuevas, B:
Hosp Univ Burgos, Dept Hematol, Burgos, Spain
Duran, MA:
Hosp Son Espases, Dept Hematol, Mallorca, Spain
Ramirez, MJ:
Hosp Jerez, Dept Hematol, Cadiz, Spain
Gomez-Casares, MT:
Hosp Dr Negrin, Dept Hematol, Las Palmas Gran Canaria, Spain
Mata-Vazquez, MI:
Hosp Costa del Sol, Dept Hematol, Marbella, Spain
Mora, E:
Hosp La Fe, Dept Hematol, IIS La Fe, Valencia, Spain
Gomez, M:
Hosp Clin Univ, INCLIVA, Dept Hematol, Avd Blasco Ibanez 17, Valencia 46010, Spain
Cervantes, F:
Univ Barcelona, Hosp Clin, IDIBAPS, Dept Hematol, Barcelona, Spain
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