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4827 Assessment of Quality of Life Following Allogeneic Stem Cell Transplant for Myelofibrosis

Program: Oral and Poster Abstracts
Session: 904. Outcomes Research—Malignant Conditions: Poster III
Hematology Disease Topics & Pathways:
Clinically relevant
Monday, December 3, 2018, 6:00 PM-8:00 PM
Hall GH (San Diego Convention Center)

Jeanne Palmer, MD1, Heidi E. Kosiorek, MS2*, Christine Wolschke, MD3*, Veena D. S. Fauble, MD4*, Richard Butterfield III2*, Holly Geyer, MD5*, Robyn M. Scherber, MD6, Amylou C. Dueck, PhD7, Allison Gathany, MD8, Ruben A. Mesa, MD, FACP9 and Nicolaus Kroeger, MD3

1Division of Hematology and Medical Oncology, Department of Medicine, Mayo Clinic, Phoenix, AZ
2Department of Biostatistics, Mayo Clinic, Scottsdale, AZ
3Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
4Honor Health System, Scottsdale, AZ
5Department of Medicine, Mayo Clinic, Phoenix, AZ
6Oregon Health and Science University, Portland, OR
7Department of Biostatistics, Mayo Clinic Arizona, Scottsdale, AZ
8Division of Hematology/Oncology, Dartmouth Medical Center, Hanover, NH
9UT Health San Antonio Cancer Center, San Antonio, TX

Background:

Myelofibrosis (MF) is a bone marrow disorder characterized by anemia, splenomegaly and constitutional symptoms. There has been substantial work documenting quality of life (QoL) in patients with MF, however, very little data about patients following allogeneic stem cell transplant (alloSCT) for MF. Many patients decline alloSCT due to concerns secondary to QoL.

Methods:

Medical facts and patient reported outcomes (PRO) measures were collected within a month prior to transplant, at day 30, 100 and 1 year post alloSCT. PRO measures include Brief Fatigue Inventory, Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), global assessment of change and the Myeloproliferative Neoplasms Symptom Assessment Form (MPN-SAF). The group was measured as a whole, and the patients in the upper quartile of MPN-TSS (the aggregate score of the 10 core items of the MPN-SAF) were also considered.

Results:

Fifty patients were enrolled on this study, 47 who proceeded with transplant. The median age of the patients was 63, ranging from 35-74. The majority of the patients were male (29, 66%), and Caucasian (43 (96%)). Most patients had primary MF (26, 59%), 9 patients had post-PV MF, and 9 patients had post-ET MF. Twenty patients had DIPSS Intermediate 2 risk disease, and 16 had DIPSS high risk disease. Twenty-six (51%) had a matched unrelated donor, 12 (30%) had a matched related donor and 5 (12%) had a mismatched unrelated donor. The majority of the patients had RIC regimens (35, 88%). At baseline the mean MPN-TSS was 27.7 (out of possible 100), and at day 30, day 100 and 1 year it was 24.6, 32.0, and 25.0, which reflected no significant change between the time points. Interestingly, all the MPN specific symptoms (including fevers, night sweats, pruritis, abdominal pain) had a significant improvement at least one time point following alloSCT. Patients in the highest quartile based on baseline TSS score (12 patients with scores at baseline greater than or equal to 37), had significant improvement in TSS score at day 100, headache at day 30, insomnia at day 100, night sweats at day 100, itching at day 100 and overall QOL at day 100. With regards to the FACT BMT, as would be expected, there was a significant decline in the FACT BMT total score, as well as trial outcome index (TOI) at day 30, but a return to close to baseline by one year.

In the global assessment of change, on day 30, 11 (27.5%) of patients reported feeling a little/moderately/very much better overall quality of life since their transplant and 27 (67.5%) felt a little/moderately/very much worse quality of life. At day 100, 11 (31.4%) reported better quality of life and 20 (57%) reported worsening since transplant. By one year, 17 (60.7%) reported feeling better and 7 (25%) reported worsening.

These findings did not appear to have a correlation with presence or absence of graft versus host disease. We were unable to assess the impact of conditioning as the majority of the patients had RIC conditioning.

Discussion/ Conclusions:

Our study evaluated the quality of life in patients with myelofibrosis who have undergone bone marrow transplantation. We have shown that there is very little change in symptom burden over the first year following transplant in general; however, significant improvement was observed in MF specific symptoms, and in patients who had a high symptom burden at baseline. By one year 61% felt that their QoL was better than it was prior to transplant. Our findings suggest that many of the patients do not experience a significant decline in QoL at 1 year after alloSCT, and actually report that their QoL improves. Further investigation is required to validate these findings.

Disclosures: Palmer: Novartis: Research Funding. Dueck: Phytogine: Employment; Pfizer: Honoraria; Bayer: Employment. Mesa: Genentech: Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees; Onconova: Membership on an entity's Board of Directors or advisory committees; NS Pharma: Research Funding; Janssen: Other: Travel Support (EHA 2018); Novartis: Consultancy, Other: Advisory Board; Celgene: Other: Research Funds (to institutions not investigator), Research Funding; Sierra Oncology: Consultancy, Honoraria; Otsuka: Other: Advisory Board; Gilead: Research Funding; Incyte Corporation: Research Funding, Travel Support (EHA 2018); CTI Biopharma: Research Funding; Sensei: Other: Advisory Board; Promedior: Research Funding; Pfizer: Other: Advisory Board, Research Funding; H3 Biosciences: Other: Research Funds (to institutions not investigator).

*signifies non-member of ASH