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Ferrata Storti Foundation
Haematologica 2019 Volume 104(9):1782-1788
Myeloproliferative Neoplasms
Long-term outcome after allogeneic hematopoietic cell transplantation for myelofibrosis
Marie Robin,1 Liesbeth C. de Wreede,2 Christine Wolschke,3 Johannes
Schetelig,4 Diderik-Jan Eikema,5 Maria Teresa Van Lint,6 Nina Simone
Knelange,7 Dietrich Beelen,8 Arne Brecht,9 Dietger Niederwieser,10 Antonin
Vitek,11 Wolfgang Bethge,12 Renate Arnold,13 Jürgen Finke,14 Liisa Volin,15
Ibrahim Yakoub-Agha,16 Arnon Nagler,17 Xavier Poiré,18 Hermann Einsele,19
20 21 22 23 Patrice Chevallier, Ernst Holler, Per Ljungman, Stephen Robinson,
24 25 26
Alekxandar Radujkovic, Donal McLornan, Yves Chalandon and Nicolaus
Kröger3
1Hôpital Saint-Louis, APHP, Université Paris 7, Paris, France; 2Department of Biomedical Data Sciences, LUMC, Leiden, the Netherlands and DKMS CTU, Dresden, Germany; 3University Hospital Eppendorf, Hamburg, Germany; 4Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Dresden, Germany; 5EBMT Statistical Unit, Leiden, the Netherlands; 6Ospedale San Martino, Genova, Italy; 7EBMT Data Office, Leiden, the Netherlands; 8University Hospital, Essen, Germany; 9Helios HSK Wiesbaden, Wiesbaden, Germany; 10University Hospital Leipzig, Leipzig, Germany; 11Institute of Hematology and Blood Transfusion, Prague, Czech Republic; 12Universität Tübingen, Tübingen, Germany; 13Charité Universitätsmedizin Berlin, Berlin, Germany; 14Division of Medicine I, Hematology, Oncology and Stem Cell Transplantation, University of Freiburg, Freiburg, Germany; 15HUCH Comprehensive Cancer Center, Helsinki, Finland; 16CHU de Lille, INSERM U995, Lille, France; 17Chaim Sheba Medical Center, Tel-Hashomer, Israel; 18Cliniques Universitaires St. Luc, Brussels, Belgium; 19Department of Internal Medicine II, University Hospital Würzburg, Würzburg, Germany; 20CHU Nantes, Nantes, France; 21University Regensburg, Regensburg, Germany; 22Karolinska University Hospital, Stockholm, Sweden; 23Bristol Oncology Centre, Bristol, UK; 24University of Heidelberg, Heidelberg, Germany; 25Comprehensive Cancer Centre, Department of Haematology, Kings College, London, UK and 26Hôpitaux Universitaires de Genève and Faculty of Medicine, University of Geneva, Geneva, Switzerland
ABSTRACT
Allogeneic hematopoietic stem cell transplant remains the only cura- tive treatment for myelofibrosis. Most post-transplantation events occur during the first two years and hence we aimed to analyze the outcome of 2-year disease-free survivors. A total of 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 sur- vival was 74% (71-78%) at ten years; results were better in younger indi- viduals and in women. Excess mortality was 14% (8-21%) in patients aged <45 years and 33% (13-53%) in patients aged ≥65 years. The main cause of death was relapse of the primary disease. Graft-versus-host disease (GvHD) before two years decreased the risk of relapse. Multivariable analysis of excess mortality showed that age, male sex recipient, secondary myelofi- brosis and no GvHD disease 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 two years. However, the occurrence of late complications, including late relapses, infectious complications and secondary malignancies, highlights the impor- tance of screening and monitoring of long-term survivors.
Correspondence:
MARIE ROBIN
marie.robin@aphp.fr
Received: August 24, 2018 Accepted: January 31, 2019. Pre-published: February 7, 2019.
doi:10.3324/haematol.2018.205211
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/9/1782
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