Donor types and outcomes of transplantation in myelofibrosis: a CIBMTR study

• DOI: 10.1182/bloodadvances.2024013451
• Publication Date: 2024-06-25T15:14:16Z
• Authors: Tania Jain; Noel Estrada-Merly; M. Queralt Salas; Soyoung Kim; Jakob DeVos; Min Chen; Xi Fang; Rajat Kumar; Marcio Andrade-Ca...; Hany Elmariah; Vaibhav Agrawal; Mahmoud Aljurf; Ulrike Bacher; Talha Badar; Sherif M. Badawy; Karen Ballen; Amer Beitinjaneh; Vijaya Raj Bhatt; Christopher Bredeson; Zachariah DeFilipp; Bhagirathbhai Dho...; Nosha Farhadfar; Shatha Farhan; Arpita P. Gandhi; Siddhartha Ganguly; Usama Gergis; Michael R. Grunwald; Nada Hamad; Betty K. Hamilton; Yoshihiro Inamoto; Madiha Iqbal; Omer Jamy; Mark Juckett; Mohamed A. Kharfa...; Maxwell M. Krem; Deepesh P. Lad; Jane Liesveld; Monzr M. Al Malki; Adriana K. Malone; Hemant S. Murthy; Guillermo Ortí; Sagar S. Patel; Attaphol Pawarode; Miguel-Angel Perales; Marjolein van der...; Olle Ringden; David A. Rizzieri; Alicia Rovó; Bipin N. Savani; Mary Lynn Savoie; Sachiko Seo; Melhem Solh; Celalettin Ustun; Leo F. Verdonck; John R. Wingard; Baldeep Wirk; Nelli Bejanyan; Richard J. Jones; Taiga Nishihori; Betul Oran; Ryotaro Nakamura; Bart Scott; Wael Saber; Vikas Gupta
• Keywords: Male; Adult; Transplantation Conditioning; 610; Graft vs Host Disease; unrelated donors; male; middle aged; 616; Medical Specialties; Medicine and Health Sciences; Humans; Registries; humans; Aged; Transplantation; adult; Hematopoietic Stem Cell Transplantation; registries; Hematology; Middle Aged; transplantation conditioning; Tissue Donors; aged; female; tissue donors; Treatment Outcome; Oncology; Primary Myelofibrosis; hematopoietic stem cell transplantation; primary myelofibrosis; treatment outcome; Female; Unrelated Donors

Abstract We evaluate the impact of donor types on outcomes of hematopoietic cell transplantation (HCT) in myelofibrosis, using the Center for International Blood and Marrow Transplant Research registry data for HCTs done between 2013 and 2019. In all 1597 patients, the use of haploidentical donors increased from 3% in 2013 to 19% in 2019. In study-eligible 1032 patients who received peripheral blood grafts for chronic-phase myelofibrosis, 38% of recipients of haploidentical HCT were non-White/Caucasian. Matched sibling donor (MSD)–HCTs were associated with superior overall survival (OS) in the first 3 months (haploidentical hazard ratio [HR], 5.80 [95% confidence interval (CI), 2.52-13.35]; matched unrelated (MUD) HR, 4.50 [95% CI, 2.24-9.03]; mismatched unrelated HR, 5.13 [95% CI, 1.44-18.31]; P < .001). This difference in OS aligns with lower graft failure with MSD (haploidentical HR, 6.11 [95% CI, 2.98-12.54]; matched unrelated HR, 2.33 [95% CI, 1.20-4.51]; mismatched unrelated HR, 1.82 [95% CI, 0.58-5.72]). There was no significant difference in OS among haploidentical, MUD, and mismatched unrelated donor HCTs in the first 3 months. Donor type was not associated with differences in OS beyond 3 months after HCT, relapse, disease-free survival, or OS among patients who underwent HCT within 24 months of diagnosis. Patients who experienced graft failure had more advanced disease and commonly used nonmyeloablative conditioning. Although MSD-HCTs were superior, there is no significant difference in HCT outcomes from haploidentical and MUDs. These results establish haploidentical HCT with posttransplantation cyclophosphamide as a viable option in myelofibrosis, especially for ethnic minorities underrepresented in the donor registries.