Reduced-Intensity Hematopoietic Cell Transplantation for Patients with Primary Myelofibrosis: A Cohort Analysis from the Center for International Blood and Marrow Transplant Research

Vikas Gupta, Adriana K. Malone, Parameswaran N. Hari, Kwang Woo Ahn, Zhen Huan Hu, Robert Peter Gale, Karen K. Ballen, Mehdi Hamadani, Eduardo Olavarria, Aaron T. Gerds, Edmund K. Waller, Luciano J. Costa, Joseph H. Antin, Rammurti T. Kamble, Koen M. van Besien, Bipin N. Savani, Harry C. Schouten, Jeffrey Szer, Jean Yves Cahn, Marcos J. de LimaBaldeep Wirk, Mahmoud D. Aljurf, Uday Popat, Nelli Bejanyan, Mark R. Litzow, Maxim Norkin, Ian D. Lewis, Gregory A. Hale, Ann E. Woolfrey, Alan M. Miller, Celalettin Ustun, Madan H. Jagasia, Michael Lill, Richard T. Maziarz, Jorge Cortes, Matt E. Kalaycio, Wael Saber

Research output: Contribution to journalArticle

67 Scopus citations

Abstract

We evaluated outcomes and associated prognostic factors in 233 patients undergoing allogeneic hematopoietic cell transplantation (HCT) for primary myelofibrosis (MF) using reduced-intensity conditioning (RIC). The median age at RIC HCT was 55 yr. Donors were a matched sibling donor (MSD) in 34% of RIC HCTs, an HLA well-matched unrelated donor (URD) in 45%, and a partially matched/mismatched URD in 21%. Risk stratification according to the Dynamic International Prognostic Scoring System (DIPSS) was 12% low, 49% intermediate-1, 37% intermediate-2, and 1% high. The probability of survival at 5 yr was 47% (95% confidence interval [CI], 40% to 53%). In a multivariate analysis, donor type was the sole independent factor associated with survival. Adjusted probabilities of survival at 5-yr were 56% (95% CI, 44% to 67%) for MSD, 48% (95% CI, 37% to 58%) for well-matched URD, and 34% (95% CI, 21% to 47%) for partially matched/mismatched URD (P=002). The relative risk (RR) for NRM was 3.92 (P= .006) for well-matched URD and 9.37 (P < .0001) for partially matched/mismatched URD. Trends toward increased NRM (RR, 1.7; P= .07) and inferior survival (RR, 1.37; P= .10) were observed in DIPSS intermediate-2/high-risk patients compared with DIPSS low/intermediate-1 risk patients. Our data indicate that RIC HCT is a potentially curative option for patients with MF, and that donor type is the most important factor influencing survival in these patients.

Original languageEnglish (US)
Pages (from-to)89-97
Number of pages9
JournalBiology of Blood and Marrow Transplantation
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Keywords

  • Allogeneic transplantation
  • Myelofibrosis
  • Prognosis
  • Reduced intensity

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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    Gupta, V., Malone, A. K., Hari, P. N., Ahn, K. W., Hu, Z. H., Gale, R. P., Ballen, K. K., Hamadani, M., Olavarria, E., Gerds, A. T., Waller, E. K., Costa, L. J., Antin, J. H., Kamble, R. T., van Besien, K. M., Savani, B. N., Schouten, H. C., Szer, J., Cahn, J. Y., ... Saber, W. (2014). Reduced-Intensity Hematopoietic Cell Transplantation for Patients with Primary Myelofibrosis: A Cohort Analysis from the Center for International Blood and Marrow Transplant Research. Biology of Blood and Marrow Transplantation, 20(1), 89-97. https://doi.org/10.1016/j.bbmt.2013.10.018