Decision analysis for transplant candidates with primary myelofibrosis in the ruxolitinib era
Yosuke Okada,
Hideki Nakasone,
Shunto Kawamura,
Kosuke Takano,
Kazuki Yoshimura,
Masaharu Tamaki,
Akari Matsuoka,
Takuto Ishikawa,
Tomohiro Meno,
Yuhei Nakamura,
Masakatsu Kawamura,
Junko Takeshita,
Nozomu Yoshino,
Yukiko Misaki,
Machiko Kusuda,
Aki Tanihara,
Shun-ichi Kimura,
Shinichi Kako,
Yoshinobu Kanda
Affiliations
Yosuke Okada
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Hideki Nakasone
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan; Division of Emerging Medicine for Integrated Therapeutics (EMIT), Center for Molecular Medicine, Jichi Medical University, Shimotsuke
Shunto Kawamura
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Kosuke Takano
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Kazuki Yoshimura
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Masaharu Tamaki
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Akari Matsuoka
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Takuto Ishikawa
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Tomohiro Meno
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Yuhei Nakamura
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Masakatsu Kawamura
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Junko Takeshita
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Nozomu Yoshino
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Yukiko Misaki
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Machiko Kusuda
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Aki Tanihara
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Shun-ichi Kimura
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Shinichi Kako
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
Yoshinobu Kanda
Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama
The recent progress with ruxolitinib treatment might improve quality-of-life as well as overall survival in patients with primary myelofibrosis (PMF). Therefore, the optimal timing of allogeneic hematopoietic cell transplantation (HCT) remains to be elucidated in the ruxolitinib era. We constructed a Markov model to simulate the 5-year clinical course of transplant candidates with PMF, and compared outcomes between immediate HCT and delayed HCT after ruxolitinib failure. Since older age was associated with an increased risk of mortality, we analyzed patients aged < 60 and ≥ 60 separately in subgroup analyses. The expected life years was consistently longer in delayed HCT after ruxolitinib failure regardless of patient age. Regarding quality-adjusted life years (QALYs), a baseline analysis showed that immediate HCT was inferior to delayed HCT after ruxolitinib failure (2.19 versus 2.26). In patients aged < 60, immediate HCT was equivalent to delayed HCT after ruxolitinib failure (2.31 versus 2.31). On the other hand, in patients aged ≥ 60, immediate HCT was inferior to delayed HCT after ruxolitinib failure (1.98 versus 2.21). A one-way sensitivity analysis showed that the utility of being alive without chronic graft-versus-host disease after immediate HCT was the most influential parameter for QALYs, and that a value higher than 0.836 could reverse the superiority of delayed HCT after ruxolitinib failure. As a result, delayed HCT after ruxolitinib failure is expected to be superior to immediate HCT, especially in patients aged ≥ 60, and is also a promising strategy even in those aged < 60.