The Dynamic International Prognostic Scoring System for myelofibrosis predicts outcomes after hematopoietic cell transplantation
Menée sur 170 patients atteints d'une myélofibrose (âge médian : 51,5 ans ; durée médiane de suivi : 5,9 ans) et ayant reçu, entre 1990 et 2009, une greffe de cellules hématopoïétiques provenant ou non d'un parent, cette étude montre une association entre un indice pronostique, le "Dynamic International Prognostic Scoring System", et la réponse au traitement
Studies by the International Working Group showed that the prognosis of myelofibrosis patients is predicted by the Dynamic International Prognostic Scoring System (DIPSS) risk categorization, which considers patient age, constitutional symptoms, hemoglobin, leukocyte count, and circulating blasts. We evaluated the prognostic usefulness of the DIPSS in 170 patients with myelofibrosis, 12-78 (median: 51.5) years of age, who received hematopoietic cell transplantation (HCT) between 1990-2009 from related (n=86) or unrelated donors (n=84). By DIPSS, 21 patients had low-risk disease, 48 had intermediate-1, 50 had intermediate-2, and 51 had high-risk disease. Five-year incidence of relapse, relapse-free survival, overall survival and non-relapse mortality (NRM) for all patients were 10%, 57%, 57%, and 34%, respectively. Among patients with DIPSS high-risk disease, the hazard ratio (HR) for post-HCT mortality was 4.11 (95% CI 1.44-11.78; p=0.008), and for NRM was 3.41 (95% CI 1.15-10.09; p=0.03) compared to low-risk patients. After a median follow-up of 5.9 years, the median survivals have not been reached for DIPSS risk groups low and intermediate-1, and were 7 and 2.5 years for intermediate-2 and high-risk patients, respectively. Thus, HCT was curative for a large proportion of patients with myelofibrosis, and post-HCT success was dependent upon pre-HCT DIPSS classification.
Blood , résumé, 2012