Akademik Veri Yönetim Sistemi
47TH ANNUAL MEETING OF EBMT, 14 - 17 Mart 2021, ss.143-144
O132.
Impact of Prior Jak-Inhibitor Therapy With Ruxolitinib
on Outcome After Allogeneic Stem Cell Transplantation
For Myelofibrosis. A Large EBMT-CMWP Study
Nicolaus Kröger1, Giulia Sbianchi2, Tiarlan Sirait3,
Dietrich Beelen4, Jakob Passweg5, Marie Robin6,
Radovan Vrhovac7, Grzegor Helbig8, Katja Sockel9,
Eibhlin Conneally10, Marie Thérèse Rubio11, Yves
Beguin12, Jürgen Finke13, Paolo Bernasconi14, Elena
Morozova15, Johannes Clausen16, Peter von dem Borne17,
Nicolaas Schaap18, Wilfried Schroyens19, Francesca
Patriarca20, Nicola Di Renzo21, Zeynep Arzu Yegin22,
Patrick Hayden23, Donal McLornan24,25, Ibrahim
Yakoub-Agha26
1University Medical Center Hamburg-Eppendorf, Hamburg,
Germany, 2University of Rome ‘Tor Vergata’, Rome,
Italy, 3EBMT Data Office, Leiden, Netherlands, 4Essen
University Hospital, Essen, Germany, 5University Hospital
of Basel, Basel, Switzerland, 6Hopital St. Louis, Paris,
France, 7University Hospital Center Rebro, Zagreb,
Croatia, 8Silesian Medica Academy, Katowice, Poland,
9University Hospital Dresden, Dresden, Germany, 10Hope
Directorate St. James’s Hospital, Dublin, Ireland, 11Hopital
d’Enfants, Vandoeuvre Nancy, France, 12University of
Liege and CHU of Liege, Liege, Belgium, 13University of
Freiburg, Freiburg, Germany, 14IRCCS Policlinico San
Matteo, Pavia, Italy, 15Pavlov First Saint Petersburg State
Medical University of St. Petersburg, St. Petersburg,
Russian Federation, 16Ordensklinikum Linz - Elisabethinen,
Linz, Austria, 17Leiden University Hospital, Leiden, Netherlands,
18Nijmegen Medical Centre, Nijmegen, Netherlands,
19Antwerp University Hospital (UZA), Antwerp Edegem,
Belgium, 20University Hospital and DAME, Udine, Italy,
21Unita Operativa di Ematologia e Trapianto di Cellule
Staminali, Lecce, Italy, 22Gazi University Faculty of
Medicine, Ankara, Turkey, 23Trinity College Dublin, St.
James’s Hospital, Dublin 8, Ireland, 24Guy’s Hospital,
London, United Kingdom, 25University College London
Hospital, London, United Kingdom, 26CHU de Lille, Univ
Lille, INSERM U 1286, Infinite, Lille, France
Background: JAK1/2 inhibitor ruxolitinib reduces spleen
size and improves constitutional symptoms in patients with
myelofibrosis but the impact of pretreatment with ruxolitinib
on outcome after allogeneic stem cell transplantation
(HSCT) remains to be determined.
Methods: We evaluated the impact of ruxolitinib on
outcome in 551 myelofibrosis patients who received
allogeneic HSCT between 2012 and 2016 either without
(n = 274) or with (n = 277) ruxolitinib pretreatment. In the
ruxolitinib pretreated group were more intermediate-2/high
risk patients according to DIPSS and more patients with
Karnofsky score ≤ 80. Ruxolitinib pretreated patients were
separated into at transplantation responsive and no responsive/
or lost response patients.
Results: Ruxolitinib rebound phenomenon after discontinuation
was noted in 6%. The overall leukocyte engraftment
on day 45 was 92% and significantly higher in ruxo
responsive patients than those who had no or lost response
to ruxolitinib (94% vs. 85%, p = 0.05). The 1 year nonrelapse
mortality was 22% (95% CI: 18 – 25) without
significant difference between the arms. In a multivariate
analysis (MVA) ruxo pretreated patients with ongoing
spleen response at transplant had a significantly lower risk
of relapse [8.1% vs. 19.1%; HR: 0.34 (95% CI 0.12 – 0.95 p = 0.04)] and better 2-year event-free survival [68.9% vs.
53.7%; HR: 0.61 (95% CI 0.40 – 0.91, p = 0.02)] in
comparison to patients without ruxolitinib pretreatment. For
overall survival the only significant factors were age > 58
years (HR: 1.42, 95% CI 1.04 – 1.95, p = 0.03) and HLA
mismatch donor (HR: 2.37, 95% CI 1.40 – 4.03, p = 0.001).
Conclusions: Ruxolitinib prior to allogeneic HSCT in
myelofibrosis is feasible and does not negatively impact
outcome after transplantation. Ruxolitinib pretreated
patients with ongoing spleen response at time of transplantation
have a better leukocyte engraftment and a lower
relapse rate resulting in an improved event-free survival in
comparison to patients who received HSCT after failure to
ruxolitinib.