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Stem cell transplantation

Determinants of survival in myelofibrosis patients undergoing allogeneic hematopoietic cell transplantation

Leukemia volume 35, pages 215–224 (2021)Cite this article

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Abstract

We aimed to evaluate the determinants of survival in myelofibrosis patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) and to describe factors predicting the main post-HCT complications. This retrospective study by the European Society for Blood and Marrow Transplantation included 2916 myelofibrosis patients who underwent first allo-HCT from an HLA-identical sibling or unrelated donor between 2000 and 2016. After a median follow-up of 4.7 years from transplant, projected median survival of the series was 5.3 years. Factors independently associated with increased mortality were age ≥ 60 years and Karnofsky Performance Status <90% at transplant, and occurrence of graft failure, grades III–IV acute graft-vs.-host disease (aGVHD), and disease progression/relapse during follow-up. The opposing effects of chronic graft-vs.-host disease (GVHD) on non-relapse mortality and relapse incidence resulted in a neutral influence on survival. Graft failure increased in unrelated donor recipients and decreased with myeloablative conditioning (MAC) and negative donor/recipient cytomegalovirus serostatus. Risk of grades III–IV aGVHD was higher with unrelated donors and decreased with MAC. Relapse incidence tended to be higher in patients with intermediate-2/high-risk DIPSS categories and to decrease in CALR-mutated patients. Acute and chronic GVHD reduced the subsequent risk of relapse. This information has potential implications for patient counseling and clinical decision-making.

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Fig. 1
Fig. 2: Cumulative incidence of major prognostic events occurring after allogeneic hematopoietic cell transplantation in patients with myelofibrosis.
Fig. 3: Unadjusted survival by risk factor after transplant in 2916 patients with myelofibrosis.
Fig. 4: Non-relapse mortality by risk factor after transplant in 2916 patients with myelofibrosis undergoing allo-HCT.

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Acknowledgements

We are indebted to all centers participating to the EBMT database.

Author information

Authors and Affiliations

  1. Hematology Department, Hospital Clínico Universitario-INCLIVA, University of Valencia, Valencia, Spain

    Juan Carlos Hernández-Boluda

  2. Hemotherapy and Hemostasis Department, Hospital Clínic, Barcelona, Spain

    Arturo Pereira

  3. University Hospital Eppendorf, Hamburg, Germany

    Nicolaus Kröger

  4. University Hospital, Essen, Germany

    Dietrich Beelen

  5. Hopital Saint Louis, Assistance Publique Hôpitaux de Paris, Université Paris 7, Paris, France

    Marie Robin

  6. University Hospital, TU Dresden, Dresden, Germany

    Martin Bornhäuser

  7. Ospedale San Martino, Genoa, Italy

    Emanuele Angelucci

  8. Institute of Hematology and Blood Transfusion, Prague, Czech Republic

    Antonin Vitek

  9. Charité Universitaetsmedizin, Berlin, Germany

    Igor Wolfgang Blau

  10. HUCH Comprehensive Cancer Center, Helsinki, Finland

    Riitta Niittyvuopio

  11. Division of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, Medical Center University of Freiburg, Freiburg, Germany

    Jürgen Finke

  12. Erasmus MC Cancer Center, Rotterdam, The Netherlands

    Jan J. Cornelissen

  13. University Hospital, Basel, Switzerland

    Jakob Passweg

  14. University of Heidelberg, Heidelberg, Germany

    Peter Dreger

  15. University Medical Center, Utrecht, The Netherlands

    Eefke Petersen

  16. Universitaet Tuebingen, Tuebingen, Germany

    Lothar Kanz

  17. University Hospital La Fe, Valencia, Spain

    Jaime Sanz

  18. Rambam Medical Center, Haifa, Israel

    Tsila Zuckerman

  19. EBMT Data Office Leiden, Leiden, The Netherlands

    Nienke Zinger

  20. Department of Biology, University of Rome Tor Vergata, Rome, Italy

    Simona Iacobelli

  21. Department of Haematology, Trinity College Dublin, St. James’s Hospital, Dublin, Ireland

    Patrick Hayden

  22. Maria Skłodowska-Curie Institute—Cancer Center, Gliwice, Poland

    Tomasz Czerw

  23. Departments of Haematology and Stem Cell Transplantation, Guys’ and St. Thomas’ NHS Foundation Trust and University College London Hospitals, London, UK

    Donal McLornan

  24. CHU de Lille, LIRIC, INSERM U995, Université de Lille, 59000, Lille, France

    Ibrahim Yakoub-Agha

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Correspondence to Juan Carlos Hernández-Boluda.

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Hernández-Boluda, J.C., Pereira, A., Kröger, N. et al. Determinants of survival in myelofibrosis patients undergoing allogeneic hematopoietic cell transplantation. Leukemia 35, 215–224 (2021). https://doi.org/10.1038/s41375-020-0815-z

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