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Haematologica. 2019 Feb 7. pii: haematol.2018.205211. doi: 10.3324/haematol.2018.205211. [Epub ahead of print]

Long-term outcome after allogeneic hematopoietic cell transplantation for myelofibrosis.

Author information

1
Hôpital Saint-Louis, APHP, Université Paris 7, Paris, France; marie.robin@sls.aphp.fr.
2
Dept. of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
3
University Hospital Eppendorf, Hamburg, Germany.
4
Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden.
5
EBMT Statistical Unit, Leiden, The Netherlands.
6
Ospedale San Martino, Genova, Italy.
7
EBMT Data office, Leiden, The Netherlands.
8
University Hospital, Essen, Germany.
9
Helios HSK Wiesbaden, Wiesbaden, Germany.
10
University Hospital Leipzig, Leipzig, Germany.
11
Institute of Hematology and Blood Transfusion, Prague, Czech Republic.
12
Universität Tübingen, Tübingen, Germany.
13
Charité Universitätsmedizin Berlin, Berlin, Germany.
14
Div. of Medicine I, hematology, Oncology & stem cell transplantation, Univ. of Freiburg, Germany.
15
HUCH Comprehensive Cancer Center, Helsinki, Finland.
16
CHU de Lille, INSERM U995, Lille, France.
17
Chaim Sheba Medical Center, Tel-Hashomer, Israel.
18
Cliniques Universitaires St. Luc, Brussels, Belgium.
19
Department of Internal Medicine II, University hospital Würzburg, Germany.
20
CHU Hotel Dieu, Nantes, France.
21
University Regensburg, Regensburg, Germany.
22
Karolinska University Hospital, Stockholm, Sweden.
23
Bristol Oncology Centre, Bristol, UK.
24
University Hospital Heidelberg, Germany.
25
Comprehensive Cancer Centre, Department of Haematology, Kings College, London, UK.
26
Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Abstract

Allogeneic hematopoietic stem cell transplant remains the only curative treatment for myelofibrosis. Most post-transplantation events occur during the first 2 years and hence we aimed to analyze the outcome of 2-year disease-free survivors. 1055 patients with myelofibrosis transplanted between 1995 and 2014 and registered in the registry of the European Society for Blood and Marrow Transplantation were included. Survival was compared to the matched general population to determine excess mortality and the risk factors that are associated. In the 2-year survivors, Disease-free survival was 64% (60-68%) and Overall Survival was 74% (71-78%) at 10 years, better in younger individuals and in women. Excess mortality was 14% (8-21%) in patients < 45 years and 33% (13-53%) in patients ≥ 65 years. The main cause of death was relapse of the primary disease. Graft versus Host Disease before 2 years decreased the risk of relapse. Multivariable analysis of excess mortality showed that age, male sex recipient, secondary myelofibrosis and no GVHD prior to the 2-year landmark increased the risk of excess mortality. This is the largest study to date analyzing long-term outcome in patients with myelofibrosis undergoing transplant. Overall it shows a good survival in patients alive and in remission at 2-years but the occurrence of late complications, including late relapses, infectious complications and secondary malignancies highlights the importance of screening and monitoring of long-term survivors.

KEYWORDS:

Chronic Myeloproliferative Disorders; Graft-versus-Host-Disease; Hematopoietic Stem Cell

PMID:
30733269
DOI:
10.3324/haematol.2018.205211
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