Cancers (Oct 2023)
A Prognostic Model to Predict Ruxolitinib Discontinuation and Death in Patients with Myelofibrosis
- Francesca Palandri,
- Giuseppe A. Palumbo,
- Massimiliano Bonifacio,
- Elena M. Elli,
- Mario Tiribelli,
- Giuseppe Auteri,
- Malgorzata M. Trawinska,
- Nicola Polverelli,
- Giulia Benevolo,
- Alessia Tieghi,
- Fabrizio Cavalca,
- Giovanni Caocci,
- Eloise Beggiato,
- Gianni Binotto,
- Francesco Cavazzini,
- Maurizio Miglino,
- Costanza Bosi,
- Monica Crugnola,
- Monica Bocchia,
- Bruno Martino,
- Novella Pugliese,
- Marta Venturi,
- Alessandro Isidori,
- Daniele Cattaneo,
- Mauro Krampera,
- Fabrizio Pane,
- Daniela Cilloni,
- Gianpietro Semenzato,
- Roberto M. Lemoli,
- Antonio Cuneo,
- Elisabetta Abruzzese,
- Filippo Branzanti,
- Nicola Vianelli,
- Michele Cavo,
- Florian Heidel,
- Alessandra Iurlo,
- Massimo Breccia
Affiliations
- Francesca Palandri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, 40138 Bologna, Italy
- Giuseppe A. Palumbo
- Department of Scienze Mediche, Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, 95124 Catania, Italy
- Massimiliano Bonifacio
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, 37129 Verona, Italy
- Elena M. Elli
- Hematology Division, Fondazione IRCCS, San Gerardo dei Tintori, 20900 Monza, Italy
- Mario Tiribelli
- Division of Hematology and BMT, Azienda Sanitaria Universitaria Integrata di Udine, 33100 Udine, Italy
- Giuseppe Auteri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, 40138 Bologna, Italy
- Malgorzata M. Trawinska
- Division of Hematology, Sant’Eugenio Hospital, Tor Vergata University, 00133 Rome, Italy
- Nicola Polverelli
- Unit of Blood Diseases and Stem Cells Transplantation, Department of Clinical and Experimental Sciences, University of Brescia, ASST Spedali Civili of Brescia, 25121 Brescia, Italy
- Giulia Benevolo
- Città della Salute e della Scienza Hospital, University Hematology Division, 10126 Torino, Italy
- Alessia Tieghi
- Department of Hematology, Azienda USL—IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy
- Fabrizio Cavalca
- Hematology Division, Fondazione IRCCS, San Gerardo dei Tintori, 20900 Monza, Italy
- Giovanni Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, 09124 Cagliari, Italy
- Eloise Beggiato
- Città della Salute e della Scienza Hospital, University Hematology Division, 10126 Torino, Italy
- Gianni Binotto
- Unit of Hematology and Clinical Immunology, University of Padova, 35122 Padova, Italy
- Francesco Cavazzini
- Division of Hematology, University of Ferrara, 44121 Ferrara, Italy
- Maurizio Miglino
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, 16126 Genova, Italy
- Costanza Bosi
- Division of Haematology, AUSL di Piacenza, 29121 Piacenza, Italy
- Monica Crugnola
- Division of Hematology, Azienda Ospedaliero, Universitaria di Parma, 43126 Parma, Italy
- Monica Bocchia
- Hematology Unit, Azienda Ospedaliera Universitaria Senese, University of Siena, 53100 Siena, Italy
- Bruno Martino
- Division of Hematology, Azienda Ospedaliera ‘Bianchi Melacrino Morelli’, 89124 Reggio Calabria, Italy
- Novella Pugliese
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, 80138 Naples, Italy
- Marta Venturi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, 40138 Bologna, Italy
- Alessandro Isidori
- Haematology and Haematopoietic Stem Cell Transplant Center, AORMN Hospital, 61100 Pesaro, Italy
- Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Mauro Krampera
- Department of Engineering for Innovation Medicine, Section of Innovation Biomedicine, Hematology Area, University of Verona, 37129 Verona, Italy
- Fabrizio Pane
- Department of Clinical Medicine and Surgery, Hematology Section, University of Naples “Federico II”, 80138 Naples, Italy
- Daniela Cilloni
- Department of Clinical and Biological Sciences, University of Turin, 10124 Turin, Italy
- Gianpietro Semenzato
- Unit of Hematology and Clinical Immunology, University of Padova, 35122 Padova, Italy
- Roberto M. Lemoli
- Clinic of Hematology, Department of Internal Medicine (DiMI), University of Genoa, 16126 Genova, Italy
- Antonio Cuneo
- Division of Hematology, University of Ferrara, 44121 Ferrara, Italy
- Elisabetta Abruzzese
- Division of Hematology, Sant’Eugenio Hospital, Tor Vergata University, 00133 Rome, Italy
- Filippo Branzanti
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, 40138 Bologna, Italy
- Nicola Vianelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, 40138 Bologna, Italy
- Michele Cavo
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto di Ematologia “Seràgnoli”, 40138 Bologna, Italy
- Florian Heidel
- Internal Medicine II, Hematology and Oncology, Friedrich-Schiller-University Medical Center, 07747 Jena, Germany
- Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Massimo Breccia
- Department of Translational and Precision Medicine, Sapienza University, 00185 Rome, Italy
- DOI
- https://doi.org/10.3390/cancers15205027
- Journal volume & issue
-
Vol. 15,
no. 20
p. 5027
Abstract
Most patients with myelofibrosis (MF) discontinue ruxolitinib (JAK1/JAK2 inhibitor) in the first 5 years of therapy due to therapy failure. As the therapeutic possibilities of MF are expanding, it is critical to identify patients predisposed to early ruxolitinib monotherapy failure and worse outcomes. We investigated predictors of early ruxolitinib discontinuation and death on therapy in 889 patients included in the “RUX-MF” retrospective study. Overall, 172 patients were alive on ruxolitinib after ≥5 years (long-term ruxolitinib, LTR), 115 patients were alive but off ruxolitinib after ≥5 yrs (short-term RUX, STR), and 123 patients died while on ruxolitinib after p = 0.08). Overall survival (OS) was significantly longer in LTR pts (p = 0.002). In multivariate analysis, PLT 9/L, Hb < 10 g/dL, primary MF, absence of spleen response at 3 months and ruxolitinib starting dose <10 mg BID were associated with higher probability of STR. Assigning one point to each significant variable, a prognostic model for STR (STR-PM) was built, and three groups were identified: low (score 0–1), intermediate (score 2), and high risk (score ≥ 3). The STR-PM may identify patients at higher risk of failure with ruxolitinib monotherapy who should be considered for alternative frontline strategies.
Keywords
