jak2 inhibitors and allografting andrea bacigalupo , genova, italy
DESCRIPTION
JAK2 INHIBITORS AND ALLOGRAFTING Andrea Bacigalupo , Genova, Italy. Significant reduction of spleen size with ruxolitinib. Significant survival advantage for ruxolitinib. Thus spleen size = progression Reduction of spleen size = control of progression - PowerPoint PPT PresentationTRANSCRIPT
JAK2 INHIBITORS AND ALLOGRAFTING
Andrea Bacigalupo, Genova, Italy
Significant reducti
on of
spleen size w
ith ru
xoliti
nib
Significant survival
advantage for ru
xoliti
nib
survival advantage is
superior w
ith
greater spleen siz
e reducti
on
Thus spleen siz
e = progression
Reduction of sp
leen size = co
ntrol o
f
progression
Reduction of tu
mour masss
?
results of allogeneic hemopoietic stem cell transplants (HSCT) are dependent on disease phase
# DIPSS# Spleen size, transfusion requirement
results of allogeneic hemopoietic stem cell transplants (HSCT) are dependent on disease phase
# DIPSS# Spleen size, transfusion requirement
0,000
0,250
0,500
0,750
1,000
0,0 2000,0 4000,0 6000,0 8000,0
days from transplant
surv
iva
l
Spleen >22 cm; n=31
Spleen <22 cm; n=29
P=0.0008
23%
68%
SPLEEN SIZE AND SURVIVAL in 70 allografted MF (GE SM)
0,000
0,250
0,500
0,750
1,000
0,0 666,7 1333,3 2000,0 2666,7 3333,3 4000,0
Survival Plot
C68
Su
rviv
al
CD34 <8 /cmm n=13
24%
66%
CD34 PB cell counts and SURVIVAL in 70 allografted MF (GE SM)
CD34 9-486/cmm n=30
CD34 >486/cmm n=15
38%
Days from transplant
30
57
86
0102030405060708090
100
<8 9-484 >484
% o
f pts
with
sple
en >
22
cmSpleen size and CD34 cell count
P=0.01
CD34 cell counts
Patients with a large spleen have advanced disease
Survival after allogeneic transplant is worse in patients with a large spleen
Survival after allogeneic transplant is also worse in patients with high CD34 counts
High CD34 counts correlate with large spleen
JAK2 inhibitors can reduce spleen size
JAK2 inhibitors are good candidates for treatment BEFORE an allogeneic transplant
Also AFTER an allogeneic transplant
Cervantes et al Blood 2009; 113: 2895: IPSS
Low = 5% /year
Int-1 = 6.7% /year
Death rate
Int-2 = 8.3% /year
High = 25% /year
Good outcome after S
CT
Poor outco
me after SCT
Good outcome after S
CT
Riulitinib
Reduction of tu
mour
mass
Improved outco
me after
SCT ??
Conclusion
SCT transplant outcome is dependent on disease phase
Ruxolitinib may improve SCT outcome for patients with advanced disease