T he selection process for transplant eligibility in myelofibrosis involves various factors such as age, dis – ease stage, comorbidities, performance status, and donor availability. Tools like the Myelofibrosis Transplant Scoring System and the Center for International Blood and Marrow Transplant Research/European Society for Blood and Mar – row Transplant (CIBMTR/ EBMT) score are instrumental in stratifying patients by their risk of non-re lapse mortality (NRM) and overall survival (OS). However, these scores may be limited by a lack of pretrans-plant comorbidity and BMI data, according to a recent correspondence in the American Journal of Hematology.

The Chronic Malignancies Working Party of the EBMT conducted a retrospective study to assess the impact of comorbidities and BMI on transplant outcomes in patients with myelofibrosis. They used the Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) to determine risk.

Nicola Polverelli, MD, PhD, and colleagues analyzed data from 4,086 patients. Of these, 3,157 patients had fully reported comorbidity data. Approximately half (54%) of the patients had at least one comorbidity, with pulmonary conditions being the most common. The HCT-CI scores categorized 54% of patients as low risk, 24% as intermediate risk, and 22% as high risk. High risk patients more frequently underwent reduce dintensity conditioning regimens, had lower Karnofsky Performance Scores, and had a higher prevalence of splenectomy. “Compared to previous cohorts in which the HCT-CI had been developed and subsequently validated, the prevalence of comorbidities was higher in our study.

Overall, these differences underscore a significant shift in the characteristics of the transplant population over time, as transplantation is increasingly considered in older patients with comorbidities,” Dr. Polverelli and colleagues reported. The researchers found that higher HCT-CI scores were significantly associated with both increased nonrelapse mortality (NRM) and decreased OS. The 5-year NRM was 27%, 33%, and 36% for low, intermediate, and high-risk groups, respectively, while OS was 58%, 52%, and 46%. The study included 2,679 patients with BMI data, classified into underweight, normal weight, overweight, and obese categories.

The researchers observed no significant differences in NRM or OS across BMI groups, suggesting that over – weight and obese patients should not be excluded from transplantation. However, significant weight loss (>10%) before transplant was associated with higher NRM, leading researchers to emphasize the importance of nutritional optimization. “Future research should aim to validate these findings and explore the possibility of integrating comorbidity assessment alongside existing scoring systems and splenomegaly evaluation,” Dr. Polverelli and coauthors concluded.