Association of Factors influencing selection of upfront hematopoietic cell transplantation versus non-transplant therapies in Myelofibrosis: Transplant decisions in MF.

Abstract Background: Despite the curative potential of allogeneic hematopoietic cell transplantation (HCT) for myelofibrosis (MF), a significant number of patients do not undergo HCT. Factors influencing treatment preferences are not well studied in MF. Objective(s): This study's objective was to identify patient, disease, and donor-related factors influencing HCT decision in MF. A secondary objective was to compare survival in patients who elected upfront HCT or non-transplant therapy. Study Design: We conducted a retrospective chart review amongst patients meeting criteria for transplant indication, evaluating clinical characteristics, treatment preferences, and outcomes. Results: Of the 183 study eligible patients 60 years was significantly associated with higher rates of HLA-typing refusal (13/72 vs. 1/44, p = 0.02). Caucasian ethnicity was significantly associated with an increased rate of identifying well matched donors compared to non-Caucasian (75% vs. 48%, p = 0.02). Of the 69 patients with well-matched donors, 34 (49%) preferred not to pursue upfront HCT despite a transplant indication. Patient preferences for non-transplant therapies was the most common reason for declining HCT. We did not find any difference in survival between patients pursuing upfront HCT versus non-transplant therapies, although more patients were in remission in the HCT arm at the last follow-up. Conclusion(s): Caucasian ethnicity patients were significantly more likely to identify a well-matched donor compared to non-Caucasian patients. Despite availability of a well-matched donor, a significant proportion of MF patients with transplant indication do not pursue HCT. Patient age, donor type and patient preferences play a major part in selection of upfront HCT. While a survival difference was not observed between upfront HCT versus non-transplant therapy, more patients in the HCT arm were in remission at the last follow up.