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Biol Blood Marrow Transplant. 2014 Jan;20(1):89-97. doi: 10.1016/j.bbmt.2013.10.018. Epub 2013 Oct 23.

Reduced-intensity hematopoietic cell transplantation for patients with primary myelofibrosis: a cohort analysis from the center for international blood and marrow transplant research.

Author information

1
Princess Margaret Cancer Center, University of Toronto, Toronto, Canada. Electronic address: vikas.gupta@uhn.on.ca.
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.

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.

KEYWORDS:

Allogeneic transplantation; Myelofibrosis; Prognosis; Reduced intensity

PMID:
24161923
PMCID:
PMC3886623
DOI:
10.1016/j.bbmt.2013.10.018
[Indexed for MEDLINE]
Free PMC Article

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