Prognostic risk models for transplant decision-making in myelofibrosis

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...

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Bibliographic Details
Published in:Annals of hematology 2018-05, Vol.97 (5), p.813-820
Main Authors: Hernández-Boluda, Juan-Carlos, Pereira, Arturo, Correa, Juan-Gonzalo, Alvarez-Larrán, Alberto, Ferrer-Marín, Francisca, Raya, José-María, Martínez-López, Joaquín, Velez, Patricia, Pérez-Encinas, Manuel, Estrada, Natalia, García-Gutiérrez, Valentín, Fox, María-Laura, Payer, Angel, Kerguelen, Ana, Cuevas, Beatriz, Durán, María-Antonia, Ramírez, María-José, Gómez-Casares, María-Teresa, Mata-Vázquez, María-Isabel, Mora, Elvira, Gómez, Montse, Cervantes, Francisco
Format: Article
Language:English
Subjects:
Aged
Clinical decision making
Clinical Decision-Making - methods
Decision making
Female
Hematology
Humans
Longitudinal Studies
Male
Medicine
Medicine & Public Health
Middle Aged
Oncology
Original Article
Patients
Primary Myelofibrosis - diagnosis
Primary Myelofibrosis - epidemiology
Primary Myelofibrosis - therapy
Prognosis
Registries
Risk Factors
Spain - epidemiology
Stem Cell Transplantation - methods
Transplantation, Homologous - methods
Transplants & implants
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Summary: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.
ISSN:0939-5555
1432-0584
DOI:10.1007/s00277-018-3240-x