Different outcome of allogeneic transplantation in myelofibrosis using conventional or reduced‐intensity conditioning regimens

Abstract

SummaryAllogeneic haematopoietic stem cell transplantation remains the only curative treatment of myelofibrosis with myeloid metaplasia (MMM). Previous reports have indicated significant treatment-related mortality (TRM) for patients transplanted after myeloablative conditioning but superior survival has been reported after reduced-intensity conditioning (RIC). We report the results of a survey of all allogeneic transplantations for MMM performed in Sweden at six transplant units between 1982 and 2004. Twenty-seven patients were transplanted; 17 with a myeloablative conditioning regimen and 10 with RIC. The median age was 50 years (5-63 years) at transplantation. After a median follow up of 55 months, 20 patients are alive. TRM was 10% in the RIC group and 30% in the myeloablative group. There was no difference in survival for high or low-risk patients according to Cervantes score or between sibling and unrelated donor transplantations.

Allogeneic hemopoietic SCT for patients with primary myelofibrosis: a predictive transplant score based on transfusion requirement, spleen size and donor type

“…Several studies have been published [6][7][8][9][10][11][12][13][14][15][16]25 using either myeloablative or RIC regimens. The main finding is that a proportion of PMF can be controlled with an allogeneic transplant and long-term disease-free survival can be achieved.…”

“…[6][7][8][9][10][11][12][13][14][15][16] Usually, PMF patients are referred for allogeneic HSCT when the Dupriez's risk score, 2 based on Hb and WBC count, is intermediate or high, whereas patients with a low-risk disease are usually monitored without treatment until progression. Other risk-assessment scores for transplant eligibility have been introduced.…”

Allo-SCT for myelofibrosis: reversing the chronic phase in the JAK inhibitor era?

“…RIC is associated with a lower NRM, but a higher risk of relapse, compared with standard myeloablative conditioning, and the current results suggest a qualified success (Table 1). [17][18][19][20][21] The notion of using ruxolitinib in order to reduce constitutional symptoms and splenomegaly prior to allo-SCT appears attractive. What is not known is the drug's impact on short-and long-term outcomes following allo-SCT; nor is the precise timing of allo-SCT or the role of allo-SCT-specific prognostic and predictive scores in the JAK-inhibitor era known.…”

The outcome of allo-HSCT for 92 patients with myelofibrosis in the Nordic countries

“…13 The Swedish MPD Study Group reported the Swedish MF SCT experience during the period 1982-2004. 7 The aim of the present study was to report all patients with MF in chronic phase treated with allo-MAC SCT and allo-RIC SCT from the six Swedish, the one Danish, the one Norwegian and one of two Finnish transplant centers. The aim was to study survival rates, the need for donor lymphocyte infusion (DLI), the rate of GVHD, TRM and the complication frequency after MAC and RIC transplantations for MF.…”

“…5 It is a chronic disorder characterized by anemia, BM fibrosis, extramedullary hematopoiesis, leukoerythroblastosis and hepatosplenomegaly. 6 The disease primarily affects the elderly, with a median age, at diagnosis, of 67 years in one study 7 and 75 years in another. 8 Several prognostic scores have been published.…”