Allogeneic bone marrow transplantation for agnogenic myeloid metaplasia

Abstract

Agnogenic myeloid metaplasia is a rare indication for allogeneic bone marrow transplantation (BMT). We have retrospectively studied 12 patients allografted for this disease within the French BMT group. Prior to BMT, the mean age was 40 years (range 14–49). Diagnosis was based on the Polycythaemia Vera Study Group criteria. Before BMT, 10 patients had been splenectomized, eight required transfusions, and four had received at least two lines of chemotherapy. Cyclophosphamide and total body irradiation was the main conditioning regimen used (n=8). The donor was an HLA‐identical sibling except in one case where there was one HLA‐DR mismatch. Acute graft‐versus‐host disease (GVHD) prophylaxis consisted of methotrexate and cyclosporine A. 11 patients engrafted with median times to achieve absolute neutrophil count > 0.5 × 109/l and platelet count > 50 × 109/l of 17 (range 12–44) and 29 (range 12–196) days respectively. One primary graft failure occurred. 10 patients developed grade II–IV acute GVHD, four developed extensive chronic GVHD. One patient relapsed 16 months post‐BMT and was untreated and well 14 months later. Three patients died from the BMT procedure. In May 1996 the median follow‐up was 25 months and the 4‐year overall and event‐free survivals were 71% and 59%, respectively. Thus, we conclude that extensive myelofibrosis is not associated with delayed engraftment, and that HLA‐identical sibling allogeneic BMT can be considered in a small proportion of patients with agnogenic myeloid metaplasia.

Allogeneic stem cell transplantation as treatment for myelofibrosis

“…[18][19][20] These results have subsequently been confirmed in a number of larger series, [20][21][22][23][24][25][26][27][28] the results of which are summarized in Table 2.…”

“…The 4-year OS was 71% with a disease-free survival (DFS) of 59%. 22 Guardiola et al 23 presented a retrospective multicenter study, looking at the results of conventional allo-SCT in 55 patients with myelofibrosis. The median age at transplantation was 42 years (range: 4-53 years) with a median time from diagnosis to transplantation of 21 months (range: 2-266 months).…”

Myelofibrosis with Myeloid Metaplasia: New Developments in Pathogenesis and Treatment

“…Patients who undergo splenectomy before HSCT seem to engraft faster (83). Age has been reported as a major determinant of transplant outcome: patients younger that 45 years have a 5 year survival rate of 62%, otherwise only 14% survive 5-years post transplant (84). However, in another study, older patients had a 5-year survival rate of 50% (85).…”

Relevance and dynamics of myelofibrosis regarding hematopoietic reconstitution after allogeneic bone marrow transplantation in chronic myelogenous leukemia – a single center experience on 160 patients

“…[37][38][39][40] In comparison to CML in idiopathic-primary myelofibrosis (IMF) allogeneic BMT was in keeping with the finding that marrow fibrosis elicited no risk factor for delayed myeloid engraftment and that myelofibrosis disappeared completely within 6 months post-transplant. 9 On the other hand, contrasting this favorable outcome, absence of osteosclerosis (endophytic woven bone formation) which is usually associated with severe collagen fibrosis 25,41,42 was indicative of a shorter time to reach the platelet and neutrophil engraftment endpoints in allogeneic stem cell transplantation for agnogenic myeloid metaplasia. 11 Again, complete resolution of marrow fibrosis was observed within a median period of 6 months following transplant.…”

“…This is apparent when considering the results of bone marrow transplantation (BMT) in acute (malignant) myelosclerosis [2][3][4][5] or allogeneic BMT and stem cell transplantation in idiopathic (primary) and post-polycythemic myelofibrosis-agnogenic myeloid metaplasia. [6][7][8][9][10][11] On the other hand, a conflict of opinion still persists as to whether severe marrow fibrosis may exert an adverse effect on hematopoietic recovery in chronic myelogenous leukemia (CML) following marrow-ablative radiochemotherapy and allogeneic BMT of HLA-matched unrelated or sibling donors. 1,12 In this context, a number of caveats have to be kept in mind.…”