Risk Stratification Using Dynamic International Prognostic Scoring System and Splenomegaly in Myelofibrosis Treated
Yosuke Okada1, Kazuki Sakatoku2, Shuichi Shirane3
1Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan; Division of Emerging Medicine for Integrated Therapeutics (EMIT), Center for Molecular Medicine, Jichi Medical University, Shimotsuke, Japan.
Transplantation and Cellular Therapy
|September 5, 2025
Summary
The Dynamic International Prognostic Scoring System (DIPSS) is less effective for predicting transplant outcomes in myelofibrosis patients using JAK inhibitors. A new system, DIPSS with Splenomegaly (DIP3S), shows promise for identifying high-risk patients receiving these therapies.
Area of Science:
- Hematology
- Oncology
- Clinical Research
Background:
- The Dynamic International Prognostic Scoring System (DIPSS) is established for predicting outcomes in myelofibrosis (MF) patients undergoing stem cell transplantation.
- The increasing use of JAK inhibitors, such as Ruxolitinib, before transplantation necessitates re-evaluation of existing prognostic models.
- The prognostic value of DIPSS in MF patients treated with pre-transplant JAK inhibitors remains uncertain.
Purpose of the Study:
- To compare the prognostic impact of DIPSS in myelofibrosis patients with and without pre-transplant Ruxolitinib therapy.
- To identify potential prognostic factors for transplant outcomes in patients receiving pre-transplant Ruxolitinib.
- To develop and evaluate a novel prognostic scoring system for MF patients undergoing transplantation, particularly those treated with JAK inhibitors.
Main Methods:
- Retrospective analysis of myelofibrosis patients undergoing stem cell transplantation.
- Comparison of overall survival (OS) stratified by DIPSS scores in patients with and without pre-transplant Ruxolitinib.
- Exploratory analysis of palpable splenomegaly as a prognostic factor in Ruxolitinib-treated patients.
- Development and validation of a modified scoring system, DIPSS with Splenomegaly (DIP3S), incorporating splenomegaly.
Main Results:
- DIPSS significantly stratified OS in patients without pre-transplant Ruxolitinib (P=0.002) but not in those with it (P=0.23).
- Palpable splenomegaly emerged as a potential prognostic factor in Ruxolitinib-treated patients (HR 1.53, P=0.15).
- The novel DIP3S high-risk status was independently associated with inferior OS (HR 2.20, P=0.027), delayed neutrophil engraftment (HR 0.54, P<0.001), and delayed platelet engraftment (HR 0.32, P<0.001).
Conclusions:
- DIPSS loses prognostic value in myelofibrosis patients treated with pre-transplant Ruxolitinib.
- The DIP3S scoring system demonstrates potential for identifying high-risk patients among those receiving pre-transplant JAK inhibitors.
- Further validation studies are required to confirm the prognostic impact and clinical utility of DIP3S in this patient population.
