Outcomes of Allogeneic Hematopoietic Stem Cell Transplantation in Older Patients Aged 65 Years and Above With Myelofibrosis

This is the authors' abstract. We don't add key points for this paper.

BACKGROUND: Allogeneic hematopoietic stem cell transplantation (allo-HCT) remains the only curative option for myelofibrosis (MF) but is often underutilized in patients aged ≥ 65 due to concerns about treatment-related toxicity. METHODS: We conducted a retrospective analysis of chronic-phase MF allo-HCT recipients using the publicly available CIBMTR P-5640 dataset (2008-2019). Key endpoints included overall survival (OS), disease-free survival (DFS), relapse, nonrelapse mortality (NRM), and graft-vs-host disease (GVHD)-related outcomes. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox regression models. Statistical analysis was performed using R (v4.3.2), with statistical significance defined as P < .05. RESULTS: We included 856 MF allo-HCT recipients (aged ≥ 65: n = 259, aged < 65: n = 597). The 2-year OS, DFS, and GVHD-free, relapse-free survival (GRFS) for patients ≥ 65 years were 62%, 33%, and 12%, respectively. Rates of relapse, NRM, grade II-IV acute GVHD, and chronic GVHD were 43%, 27%, 46%, and 42%, respectively. In multivariable analysis, age ≥ 65 years was independently associated with inferior DFS (HR 1.26, 95% CI 1.03-1.55, P = .025); however, there was no impact on other post-transplant outcomes. Independent predictors of worse outcomes in older patients included splenic radiation and ATG use, secondary MF, higher comorbidities (HCT-CI ≥ 3), mismatched donor type, and bone marrow graft. CONCLUSIONS: In myelofibrosis patients aged 65 years and above undergoing allogeneic HCT, a favorable 2-year overall survival of 62% was noted with an inferior DFS compared to younger patients, while other post-transplant outcomes remained comparable. These findings support allo-HCT as a viable option in selected elderly MF patients using tailored transplant strategies.