Abstract | BACKGROUND:
Myelofibrosis is a myeloproliferative stem cell disorder curable exclusively by allogeneic hematopoietic stem cell transplantation and is associated with substantial mortality and morbidity. The aim of this study was to assess disease-specific and transplant-related risk factors that influence post-transplant outcome in patients with myelofibrosis. DESIGN AND METHODS: We retrospectively assessed 76 consecutive patients with primary (n=47) or secondary (n=29) myelofibrosis who underwent bone marrow (n=6) or peripheral blood stem cell (n=70) transplantation from sibling ( n=30) or unrelated (n=46) donors between January 1994 and December 2010. The median follow-up of surviving patients was 55 ± 7.5 months. RESULTS: Primary graft failure occurred in 5% and the non-relapse mortality rate at 1 year was 28%. The relapse-free survival rate was 50% with a relapse rate of 19% at 5 years. The use of pharmacological pre-treatment and the post-transplant occurrence of chronic graft-versus-host disease were significant independent unfavourable risk factors for post-transplant survival in multivariate analysis. Using the Dynamic International Prognostic Scoring System for risk stratification, low-risk patients had significantly better overall survival (P=0.014, hazard ratio 1.4) and relapse-free survival (P=0.02, hazard ratio 1.3) compared to the other risk groups of patients. The additional inclusion of thrombocytopenia, abnormal karyotype and transfusion need (Dynamic International Prognostic Scoring System Plus) resulted in a predicted 5-year overall survival of 100%, 51%, 54% and 30% for low, intermediate-1, intermediate-2 and high-risk groups, respectively. The relapse incidence was significantly higher in the absence of chronic graft-versus-host disease (P=0.006), and pharmacological pre-treatment (n=43) was associated with reduced relapse-free survival (P=0.001). CONCLUSIONS:
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Authors | Markus Ditschkowski, Ahmet H Elmaagacli, Rudolf Trenschel, Tanja Gromke, Nina K Steckel, Michael Koldehoff, Dietrich W Beelen |
Journal | Haematologica
(Haematologica)
Vol. 97
Issue 10
Pg. 1574-81
(Oct 2012)
ISSN: 1592-8721 [Electronic] Italy |
PMID | 22491742
(Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
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Topics |
- Adolescent
- Adult
- Aged
- Child
- Female
- Graft vs Host Disease
(etiology)
- Hematopoietic Stem Cell Transplantation
(adverse effects)
- Humans
- Male
- Middle Aged
- Primary Myelofibrosis
(diagnosis, mortality, therapy)
- Prognosis
- Recurrence
- Risk Factors
- Transplantation, Homologous
- Treatment Outcome
- Young Adult
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