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<p>Outcomes in myelofibrosis (MF) patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) appear unaffected by the intensity of the preparative regimen, defined traditionally as myeloablative (MAC) or reduced intensity conditioning (RIC). The Transplant Conditioning Intensity (TCI) index is an objective tool offering a precise measure of conditioning intensity. We explored the potential association between TCI score and overall survival (OS), progression-free survival (PFS), cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) in 2454 MF patients undergoing allo-HCT between 2012 and 2021, selected from the EBMT registry. Patients receiving TCI-intermediate/high regimens had similar OS (HR 1.12, 95% CI 0.97–1.30) and PFS (HR 1.00, 95% CI 0.88–1.14) compared to TCI-low regimens. However, TCI-intermediate/high regimens were associated with lower risk of relapse (HR 0.74, 95% CI 0.61–0.91, <i>p</i> = 0.008) and higher risk of NRM (HR 1.24, 95% CI 1.04–1.48, <i>p</i> = 0.02). Our findings suggest that the TCI score provides a more clinically relevant stratification of conditioning intensity than the conventional MAC/RIC classification. While higher intensity TCI regimens are associated with lower RI, this benefit is offset by increased NRM, resulting in no survival advantage. However, the TCI index may enable a more personalized approach to conditioning regimen selection by balancing relapse risk with patient frailty.</p>

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Transplant conditioning intensity (TCI) score predicts allo-HCT outcomes in patients with myelofibrosis: a study of the Chronic Malignancies Working Party of EBMT

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月15日

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  • Patryk Sobieralski,
  • Tomasz Czerw,
  • Luuk Gras,
  • Linda Koster,
  • Nicolaus Kröger,
  • Thomas Schroeder,
  • Lone Friis,
  • Elisabetta Metafuni,
  • Jakob Passweg,
  • Marie Robin,
  • Matthias Stelljes,
  • Annoek E. C. Broers,
  • Patrice Chevallier,
  • Robert Zeiser,
  • Marie Therese Rubio,
  • Mareike Verbeek,
  • Ipek Yonal-Hindilerden,
  • Domenico Pastore,
  • Jan Zaucha,
  • Kavita Raj,
  • Joanna Drozd-Sokołowska,
  • Giorgia Battipaglia,
  • Nicola Polverelli,
  • Juan Carlos Hernández-Boluda,
  • Donal P. McLornan

摘要

Outcomes in myelofibrosis (MF) patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) appear unaffected by the intensity of the preparative regimen, defined traditionally as myeloablative (MAC) or reduced intensity conditioning (RIC). The Transplant Conditioning Intensity (TCI) index is an objective tool offering a precise measure of conditioning intensity. We explored the potential association between TCI score and overall survival (OS), progression-free survival (PFS), cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) in 2454 MF patients undergoing allo-HCT between 2012 and 2021, selected from the EBMT registry. Patients receiving TCI-intermediate/high regimens had similar OS (HR 1.12, 95% CI 0.97–1.30) and PFS (HR 1.00, 95% CI 0.88–1.14) compared to TCI-low regimens. However, TCI-intermediate/high regimens were associated with lower risk of relapse (HR 0.74, 95% CI 0.61–0.91, p = 0.008) and higher risk of NRM (HR 1.24, 95% CI 1.04–1.48, p = 0.02). Our findings suggest that the TCI score provides a more clinically relevant stratification of conditioning intensity than the conventional MAC/RIC classification. While higher intensity TCI regimens are associated with lower RI, this benefit is offset by increased NRM, resulting in no survival advantage. However, the TCI index may enable a more personalized approach to conditioning regimen selection by balancing relapse risk with patient frailty.