Photo Credit: Nemes Laszlo

The following is a summary of “Clearance of Driver Mutations after Transplantation for Myelofibrosis,” published in the January 2025 issue of Hematology by Gagelmann et al. 

Allogeneic hematopoietic stem-cell transplantation is the sole curative option for myelofibrosis. The impact of driver mutation clearance after transplantation remains uncertain. 

Researchers conducted a retrospective study to evaluate the role of driver mutation clearance after allogeneic hematopoietic stem-cell transplantation in myelofibrosis. 

They analyzed driver mutations in peripheral blood samples from 324 patients with myelofibrosis (73% JAK2, 23% CALR, 4% MPL) using highly sensitive polymerase chain reaction. Mutations were detected before transplantation and at 30, 100, and 180 days post-transplant to assess clearance and its effect on relapse and disease-free survival. 

The results showed mutation clearance at day 30 was observed in 42% of JAK2, 73% of CALR, and 54% of patients with MPL; at day 100, the clearance rates were 63%, 82%, and 100%, respectively. The cumulative incidence of relapse at 1 year was 6% (95% CI, 2 to 10) for patients with mutation clearance at day 30 and 21% (95% CI, 15 to 27) for those without. Disease-free and overall survival at 6 years were 61% and 74%, respectively, for patients with mutation clearance at day 30, compared to 41% and 60% for those without. Mutation clearance on day 30 was independently associated with a reduced risk of relapse or progression (hazard ratio (HR), 0.36; 95% CI, 0.21 to 0.61). 

Investigators found that mutation clearance at day 30 after transplantation improved relapse and survival outcomes in myelofibrosis, regardless of mutation type. 

Source: nejm.org/doi/full/10.1056/NEJMoa2408941