Transplant conditioning intensity (TCI) score predicts allo-HCT outcomes in patients with myelofibrosis: a study of the Chronic Malignancies Working Party of EBMT

Outcomes in myelofibrosis (MF) patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) appear unaffected by the intensity of the preparative regimen, defined traditionally as myeloablative (MAC) or reduced intensity conditioning (RIC). The Transplant Conditioning Intensity (TCI) index is an objective tool offering a precise measure of conditioning intensity. We explored the potential association between TCI score and overall survival (OS), progression-free survival (PFS), cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) in 2454 MF patients undergoing allo-HCT between 2012 and 2021, selected from the EBMT registry. Patients receiving TCI-intermediate/high regimens had similar OS (HR 1.12, 95% CI 0.97-1.30) and PFS (HR 1.00, 95% CI 0.88-1.14) compared to TCI-low regimens. However, TCI-intermediate/high regimens were associated with lower risk of relapse (HR 0.74, 95% CI 0.61-0.91, p = 0.008) and higher risk of NRM (HR 1.24, 95% CI 1.04-1.48, p = 0.02). Our findings suggest that the TCI score provides a more clinically relevant stratification of conditioning intensity than the conventional MAC/RIC classification. While higher intensity TCI regimens are associated with lower RI, this benefit is offset by increased NRM, resulting in no survival advantage. However, the TCI index may enable a more personalized approach to conditioning regimen selection by balancing relapse risk with patient frailty.

Authors

Institutions

Publication Details

Journal
Bone Marrow Transplantation
Published
2025-10-15
DOI
https://doi.org/10.1038/s41409-025-02732-w
Primary Topic
Myeloproliferative Neoplasms: Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

Transplant conditioning intensity (TCI) score predicts allo-HCT outcomes in patients with myelofibrosis: a study of the Chronic Malignancies Working Party of EBMT

Kavita K Raj, Nicolaus Martin Kröger, Jakob Robert Passweg, Matthias Stelljes et al.
Bone Marrow Transplantation
Myeloproliferative Neoplasms: Diagnosis and Treatment
article

Transplant conditioning intensity (TCI) score predicts allo-HCT outcomes in patients with myelofibrosis: a study of the Chronic Malignancies Working Party of EBMT

Kavita K Raj, Nicolaus Martin Kröger, Jakob Robert Passweg, Matthias Stelljes, Tomasz Czerw, Nicola Polverelli, Marie Robin, Donal P. McLornan, İpek Yönal Hindilerden, Giorgia Battipaglia, Patrice Chevallier, Jan Zaucha, Annoek E. C. Broers, Joanna Ewa Drozd-Sokolowska, Thomas A. Schroeder, Juan Carlos Hernández‐Boluda, Mareike Verbeek, Domenico Pastore, Luuk Gras, Robert Zeiser, Elisabetta Metafuni, Patryk Sobieralski, Marie‐Thérèse Rubio, Lone Smidstrup Friis, Linda Köster
article en

Abstract

Outcomes in myelofibrosis (MF) patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) appear unaffected by the intensity of the preparative regimen, defined traditionally as myeloablative (MAC) or reduced intensity conditioning (RIC). The Transplant Conditioning Intensity (TCI) index is an objective tool offering a precise measure of conditioning intensity. We explored the potential association between TCI score and overall survival (OS), progression-free survival (PFS), cumulative incidence of relapse (CIR) and non-relapse mortality (NRM) in 2454 MF patients undergoing allo-HCT between 2012 and 2021, selected from the EBMT registry. Patients receiving TCI-intermediate/high regimens had similar OS (HR 1.12, 95% CI 0.97-1.30) and PFS (HR 1.00, 95% CI 0.88-1.14) compared to TCI-low regimens. However, TCI-intermediate/high regimens were associated with lower risk of relapse (HR 0.74, 95% CI 0.61-0.91, p = 0.008) and higher risk of NRM (HR 1.24, 95% CI 1.04-1.48, p = 0.02). Our findings suggest that the TCI score provides a more clinically relevant stratification of conditioning intensity than the conventional MAC/RIC classification. While higher intensity TCI regimens are associated with lower RI, this benefit is offset by increased NRM, resulting in no survival advantage. However, the TCI index may enable a more personalized approach to conditioning regimen selection by balancing relapse risk with patient frailty.

Bone Marrow TransplantationVol. 61(1)
University College London Hospitals NHS Foundation Trust (GB), Universität Hamburg (DE), University of Freiburg (DE), Université Paris Cité (FR), University of Münster (DE), Medical University of Warsaw (PL), University Hospital of Basel (CH), Agostino Gemelli University Polyclinic (IT), Rigshospitalet (DK), Centre Hospitalier Universitaire de Nantes (FR), Düsseldorf University Hospital (DE), Sorbonne Paris Cité (FR), Hospital Clínico Universitario de Valencia (ES), European Society for Blood and Marrow Transplantation (NL), Ospedale A. Perrino (IT), University Medical Center Hamburg-Eppendorf (DE), Essen University Hospital (DE), München Klinik (DE), University Clinical Centre (PL), Hôpital Saint-Louis (FR), Erasmus MC Cancer Institute (NL), The Maria Sklodowska-Curie National Research Institute of Oncology (PL), Policlinico San Matteo Fondazione (IT), Heinrich Heine University Düsseldorf (DE), University College London (GB), Istanbul University (TR), University of Naples Federico II (IT), Gdańsk Medical University (PL)
Openalex Percentile: Top 59%
Myeloproliferative Neoplasms: Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.