Receiving Ruxolitinib Post Transplant Improves Survival Among Patients With Myelofibrosis

Insight into the long-term safety and efficacy of allogeneic hematopoietic cell transplantation (alloHCT) in patients with myelofibrosis is suggesting positive implications of ruxolitinib treatment for these patients when given post transplant.

A study abstract presented at the European Hematology Association annual meeting found that, in a real-world setting, ruxolitinib resulted in prolonged survival among patients receiving the treatment following alloHCT, with 2-year overall survival (OS) improving significantly from 13.1% to 100%.

“Our real-world cohort indicates that the use of ruxolitinib has optimized outcomes of alloHCT. Especially after alloHCT, our results suggest a significant benefit of a personalized approach in ruxolitinib administration,” reflected the researchers, who noted that physicians are reluctant to refer patients for alloHCT since the emergence of Janus kinase 2 inhibitors despite efforts to expand alloHCT indications with improved patient stratification. “Given the safety of alloHCT, further studies are needed to guide this personalized approach.”

Throughout the study period, disease-free survival (DFS) was also superior among patients receiving ruxolitinib post-transplant; patients who received the JAK2 inhibitor after their alloHSCT had a 2-year DFS of 75% compared with 14.3% among patients who did not.

The study included 12 patients receiving alloHCT between 2000 and 2020, 7 of whom had primary myelofibrosis and 5 had secondary myelofibrosis. The majority (8 patients) received their transplant from a sibling donor and 4 received their transplant from an unrelated donor. All 12 patients received peripheral blood stem cells graft, either after myeloablative or reduced intensity conditioning regimens.

Among the patients, there was a 2-year treatment-related mortality rate of 34.6%.

“Ruxolitinib was administered in patients transplanted after 2015: before alloHCT in 6/6 patients, and after alloHCT in 4/6 (2 for relapsed disease, 1 for splenomegaly and thrombocytopenia despite involved field radiation therapy, and 1 for moderate chronic GVHD). Patients that received ruxolitinib post-transplant did not suffer from TRM,” explained the researchers.

Acute graft-versus-host disease (GVHD) was reported in 33% of patients and cumulative incidence of moderate chronic GVHD was 58%.

Reference

Sakellari I, Gavriilaki E, Mallouri D, et al. Improved survival in myelofibrosis patients receiving ruxolotinib post allogeneic hematopoietic cell transplantation. Presented at EHA 2021. Abstract EP1256.