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- Title
Comparison of Different Treatment Strategies for Blast-Phase Myeloproliferative Neoplasms.
- Authors
Tokumori, Franco Castillo; Ali, Najla Al; Chan, Onyee; Sallman, David; Yun, Seongseok; Sweet, Kendra; Padron, Eric; Lancet, Jeffrey; Komrokji, Rami; Kuykendall, Andrew T.
- Abstract
In this retrospective analysis of 75 patients with MPN-BP with different initial treatment strategies, we showed that active treatment is associated with favorable OS. Intensive chemotherapy improves survival, but the survival benefit is mostly tied to receipt of AHSCT. Thus, chemotherapy may be a reasonable approach in appropriate patients as it can provide an effective bridge to AHSCT. Introduction: Up to 20% of patients with myeloproliferative neoplasms (MPN) will progress to blast phase (MPN-BP). Outcomes are dismal, with intensive chemotherapy providing little benefit. Low-intensity therapy is preferred due to better tolerability, but the prognosis remains poor. Allogeneic stem cell transplant (AHSCT) is still the only potential for long term survival. Patients and Methods: To better evaluate the initial treatment approach in MPN-BP, we performed a singleinstitution retrospective analysis of 75 patients with MPN-BP treated at Moffitt Cancer Center between 2001 and 2021. Patients were stratified by initial treatment: best supportive care (BSC), hypomethylating agent (HMA)-based therapy or intensive chemotherapy (IC). Results: Median overall survival (mOS) for the entire cohort was 4.8 months (BSC 0.8 months, HMA 4.7 months, and IC 11.4 months). Among IC patients, improved survival was evident in those that received AHSCT (mOS 40.8 months vs. 4.9 months, p < .01). Most patients that underwent AHSCT were initially treated with IC (p < .01). All patients that underwent AHSCT had achieved complete response (CR) or CR with incomplete hematological recovery (CRi). On multivariate analysis, factors associated with improved survival were receipt of therapy (HMA or IC) (P = .017), CR/CRi (P = .037) and receipt of AHSCT (p < .001). Conclusion: We show that active treatment with IC improves survival, but it is mostly tied to receipt of AHSCT. IC is a reasonable approach in appropriate patients as it can provide an effective bridge to AHSCT. Other treatment strategies such as molecularly targeted therapy and novel agents are desperately needed.
- Publication
Clinical Lymphoma, Myeloma & Leukemia, 2022, Vol 22, Issue 7, pe521
- ISSN
2152-2650
- Publication type
Article
- DOI
10.1016/j.clml.2022.01.015