Predicting the outcome for patients with myelofibrosis undergoing an allogeneic hemopoietic stem cell transplant

Several predictive scores have been described for patients with myelofibrosis (MF): these include IPSS [1], DIPPS [2], MYSEC [3], MIPSS [4] and GIPSS [5]. All of these have in common the identification of clinical, and biological risk factors for evolution of the disease and death. When these prognostic scores are applied to patients undergoing a hemopoietic stem cell transplant (HSCT), the outcome reflects the progression of the disease: patients with an early disease, always do better than patients with more advanced disease, and/or a higher risk score [6, 7]. The question is the following: can we identify a prognostic score, specifically designed for patients undergoing an allogeneic HSCT. A recent study has identified transplant and molecular characteristics predictive of transplant outcome, and is referred to as the MTSS or molecular and transplant scoring system. These include: age over 57, Karnovsky score < 90%, platelet counts < 150 × 10^9/L, leukocyte count > 25 × 10^9/L, an HLA mismatched donor, ASXL1 mutation, and non-CARL/MP genotype, to be independent predictors of outcome [8], The Authors incorporate these factors in 4 level MTSS, low (0–2), intermediate (3–4), high (5) and very high (>5). The OS at 5 years for these groups was 90% (low), 77% (intermediate), 50% (high) and 34% (very high). However, there is no mention of relapse in this study, and thus one wonders why introduce molecular prognostication.