Reduced-Intensity Hematopoietic Cell Transplantation for Patients with Primary Myelofibrosis: A Cohort Analysis from the Center for International Blood and Marrow Transplant Research |
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| Affiliation: | 1. Princess Margaret Cancer Center, University of Toronto, Toronto, Canada;2. Mount Sinai Medical Center, New York, New York;3. Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin;4. Section of Hematology, Division of Experimental Medicine, Department of Medicine, Imperial College, London, UK;5. Massachusetts General Hospital, Boston, Massachusetts;6. West Virginia University Hospitals, Morgantown, West Virginia;7. Hematology Department and BMT Unit, Complejo Hospitalario de Navarra, Pamplona, Spain;8. Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio;9. Bone Marrow and Stem Cell Transplant Center, Emory University Hospital, Atlanta, Georgia;10. Blood and Marrow Transplant Program, Medical University of South Carolina, Charleston, South Carolina;11. Dana Farber Cancer Institute, Boston, Massachusetts;12. Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, Texas;13. Stem Cell Transplant Program, Weill Cornell Medical College, New York, New York;14. Vanderbilt University Medical Center, Nashville, Tennessee;15. Academische Ziekenhuis Maastricht, Maastricht, The Netherlands;16. Clinical Haematology and BMT Service, Royal Melbourne Hospital, Victoria, Australia;17. Department of Hematology, University Hospital, Grenoble, France;18. Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio;19. Department of Hematology/Oncology, Shands HealthCare and University of Florida, Gainesville, Florida;20. King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia;21. Stem Cell Transplantation and Cellular Therapy, M.D. Anderson Cancer Center, Houston, Texas;22. Division of Hematology, Oncology, and Transplantation, University of Minnesota Medical Center, Minneapolis, Minnesota;23. Mayo Clinic Rochester, Rochester, Minnesota;24. Haematology and Bone Marrow Transplant Unit, Royal Adelaide Hospital/SA Pathology, Adelaide, Australia;25. All Children''s Hospital, St Petersburg, Florida;26. Baylor University Medical Center, Dallas, Texas;27. Division of Hematology/Oncology, Cedars-Sinai Medical Center, Los Angeles, California;28. Center for Hematologic Malignancies, Oregon Health and Science University, Portland, Oregon |
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| Abstract: | We evaluated outcomes and associated prognostic factors in 233 patients undergoing allogeneic hematopoietic cell transplantation (HCT) for primary myelofibrosis (MF) using reduced-intensity conditioning (RIC). The median age at RIC HCT was 55 yr. Donors were a matched sibling donor (MSD) in 34% of RIC HCTs, an HLA well-matched unrelated donor (URD) in 45%, and a partially matched/mismatched URD in 21%. Risk stratification according to the Dynamic International Prognostic Scoring System (DIPSS) was 12% low, 49% intermediate-1, 37% intermediate-2, and 1% high. The probability of survival at 5 yr was 47% (95% confidence interval [CI], 40% to 53%). In a multivariate analysis, donor type was the sole independent factor associated with survival. Adjusted probabilities of survival at 5-yr were 56% (95% CI, 44% to 67%) for MSD, 48% (95% CI, 37% to 58%) for well-matched URD, and 34% (95% CI, 21% to 47%) for partially matched/mismatched URD (P = .002). The relative risk (RR) for NRM was 3.92 (P = .006) for well-matched URD and 9.37 (P < .0001) for partially matched/mismatched URD. Trends toward increased NRM (RR, 1.7; P = .07) and inferior survival (RR, 1.37; P = .10) were observed in DIPSS intermediate-2/high-risk patients compared with DIPSS low/intermediate-1 risk patients. Our data indicate that RIC HCT is a potentially curative option for patients with MF, and that donor type is the most important factor influencing survival in these patients. |
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| Keywords: | Myelofibrosis Allogeneic transplantation Reduced intensity Prognosis |
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