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Leukemia. 2015 Nov;29(11):2126-33. doi: 10.1038/leu.2015.233. Epub 2015 Aug 21.

Indication and management of allogeneic stem cell transplantation in primary myelofibrosis: a consensus process by an EBMT/ELN international working group.

Author information

1
Department of Stem Cell Transplantation, University Hospital, Hamburg, Germany.
2
Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA, USA.
3
Department of Hematology, Hospital of Navarra, Navarra Health Service, Pamplona, Spain.
4
Department of Haematology, Clinical Oncology and Hemostasiology, University of Leipzig, Leipzig, Germany.
5
Ospedale San Martino, Genoa, Italy.
6
Research Foundation, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
7
Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
8
Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA.
9
Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
10
Academic Department of Hematology and Oncology, Johannes Wesling Teaching Hospital, Hans-Nolte-Strasse 1, Minden, Germany.
11
Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.
12
Department of Haematology Guy's and St Thomas' NHS Foundation Trust, London, UK.
13
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
14
Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
15
Department of Hematology and Bone Marrow Transplantation, Saint Louis Hospital, Paris, France.
16
Department of Bone Marrow Transplantation, WTZ, Comprehensive Cancer Centre, University Hospital Essen, Essen, Germany.
17
Mayo Clinic Cancer Center, Scottsdale, AZ, USA.
18
Department of Haematological Medicine, King's College Hospital, London, UK.
19
Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
20
Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
21
Division of Hematology, Department of Medicine, University Hospital Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
22
University of Illinois Hospital & Health Sciences System and University of Illinois Cancer Center, Chicago, IL, USA.
23
Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.

Abstract

The aim of this work is to produce recommendations on the management of allogeneic stem cell transplantation (allo-SCT) in primary myelofibrosis (PMF). A comprehensive systematic review of articles released from 1999 to 2015 (January) was used as a source of scientific evidence. Recommendations were produced using a Delphi process involving a panel of 23 experts appointed by the European LeukemiaNet and European Blood and Marrow Transplantation Group. Key questions included patient selection, donor selection, pre-transplant management, conditioning regimen, post-transplant management, prevention and management of relapse after transplant. Patients with intermediate-2- or high-risk disease and age <70 years should be considered as candidates for allo-SCT. Patients with intermediate-1-risk disease and age <65 years should be considered as candidates if they present with either refractory, transfusion-dependent anemia, or a percentage of blasts in peripheral blood (PB) >2%, or adverse cytogenetics. Pre-transplant splenectomy should be decided on a case by case basis. Patients with intermediate-2- or high-risk disease lacking an human leukocyte antigen (HLA)-matched sibling or unrelated donor, should be enrolled in a protocol using HLA non-identical donors. PB was considered the most appropriate source of hematopoietic stem cells for HLA-matched sibling and unrelated donor transplants. The optimal intensity of the conditioning regimen still needs to be defined. Strategies such as discontinuation of immune-suppressive drugs, donor lymphocyte infusion or both were deemed appropriate to avoid clinical relapse. In conclusion, we provided consensus-based recommendations aimed to optimize allo-SCT in PMF. Unmet clinical needs were highlighted.

PMID:
26293647
DOI:
10.1038/leu.2015.233
[Indexed for MEDLINE]

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