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Allogeneic stem cell transplantation for myeloproliferative neoplasm in blast phase.

Abstract
The prognosis for patients with Philadelphia-negative myeloproliferative neoplasms (MPN) who evolve into acute myeloid leukemia (AML) or blast phase (MPN-BP) is extremely poor. Although allogeneic stem cell transplantation (allo-SCT) is considered potentially curative, very few patients have been reported who have undergone allo-SCT for MPN-BP; therefore the success rate remains unknown. In a retrospective review, we identified 13 patients with an MPN transformation to blast phase after a median 9 years (range 5 months to 30 years); 8 (median age 55) continued to allo-SCT within 6 months. Induction chemotherapy cleared blood/marrow blasts in 60% (6/10) (2 declined therapy, 1 had early death). At the time of allo-SCT, 5/8 patients were in complete remission (CR) of their leukemia or had returned to MPN chronic phase (CP), 2 had residual blood blasts and 1 was refractory with >5% marrow blasts. At follow-up (median 20.3 months), 6 patients are alive in CR of both their leukemia/MPN. All 5 patients in CR/CP at pre-allo-SCT remain alive in remission, while 2/3 with persistent blood/marrow blasts relapsed and expired. We conclude that MPN-BP can be cured by allo-SCT in a significant percentage of patients, but that adequate leukemic clearance prior to allo-SCT offers an optimal outcome.
AuthorsChad Cherington, James L Slack, Jose Leis, Roberta H Adams, Craig B Reeder, Joseph R Mikhael, John Camoriano, Pierre Noel, Veena Fauble, Jeffrey Betcher, Meagan S Higgins, Ginger Gillette-Kent, Lisa D Tremblay, Mary E Peterson, Jane J Olsen, Raoul Tibes, Ruben A Mesa
JournalLeukemia research (Leuk Res) Vol. 36 Issue 9 Pg. 1147-51 (Sep 2012) ISSN: 1873-5835 [Electronic] England
PMID22578777 (Publication Type: Evaluation Study, Journal Article)
CopyrightCopyright © 2012 Elsevier Ltd. All rights reserved.
Topics
  • Adult
  • Aged
  • Blast Crisis (therapy)
  • Female
  • Follow-Up Studies
  • Hematologic Neoplasms (diagnosis, genetics, pathology, therapy)
  • Humans
  • Male
  • Middle Aged
  • Myeloproliferative Disorders (diagnosis, genetics, pathology, therapy)
  • Remission Induction
  • Retrospective Studies
  • Stem Cell Transplantation (methods)
  • Transplantation, Homologous
  • Treatment Outcome

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