title: Stem cell transplantation for myelofibrosis: a report from two Canadian centers.
abstract: We describe the course of 25 patients with myelofibrosis (MF) due to agnogenic myeloid metaplasia (n=19) or essential thrombocytosis (n=6) who underwent allogeneic stem cell transplantation (SCT) at one of two Canadian centers. The median age at transplantation was 48.7 (IQR 45.9-50.4) years and transplantation was carried out at a median of 10.7 (IQR 5.67-26.5) months after diagnosis. Granulocyte engraftment (absolute neutrophil count >0.5 x 109/l) occurred at a median of 20 days after transplantation for splenectomized patients, compared with 27.5 days for nonsplenectomized individuals (P=0.03). Increased risk of grade II-IV acute graft-versus-host disease (P=0.04) was noted in patients transplanted after splenectomy. Patients with MF received 0.264+/-0.189 U of packed red blood cells per day over the first 180 days after transplantation, and remained dependent on red blood cell transfusions for a median of 123 (IQR 48-205) days. Complete remission of MF was documented in 33% of evaluable patients. The 1 year cumulative nonrelapse mortality was 48.3%. Median survival for this group of patients was 393 (IQR 109-1014+) days, with a projected 2-year overall survival of 41%. We conclude that allogeneic SCT offers a reasonable chance for prolonged survival in patients with advanced MF, but this occurs at the cost of considerable toxicity and nonrelapse mortality.
authors.affiliation: Allogeneic Bone Marrow Transplant Program, Princess Margaret Hospital, University Health Network, Toronto, Ont., Canada.
authors.forename: A
authors.initials: A
authors.lastname: Daly
authors.forename: K
authors.initials: K
authors.lastname: Song
authors.forename: T
authors.initials: T
authors.lastname: Nevill
authors.forename: S
authors.initials: S
authors.lastname: Nantel
authors.forename: C
authors.initials: C
authors.lastname: Toze
authors.forename: D
authors.initials: D
authors.lastname: Hogge
authors.forename: D
authors.initials: D
authors.lastname: Forrest
authors.forename: J
authors.initials: J
authors.lastname: Lavoie
authors.forename: H
authors.initials: H
authors.lastname: Sutherland
authors.forename: J
authors.initials: J
authors.lastname: Shepherd
authors.forename: W
authors.initials: W
authors.lastname: Hasegawa
authors.forename: J
authors.initials: J
authors.lastname: Lipton
authors.forename: H
authors.initials: H
authors.lastname: Messner
authors.forename: T
authors.initials: T
authors.lastname: Kiss
mesh_terms: D017707:Erythrocyte Transfusion; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006504:Hepatic Veno-Occlusive Disease / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D055728:Primary Myelofibrosis / Q000150:complications / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D013156:Splenectomy; D016019:Survival Analysis; D013922:Thrombocytosis / Q000150:complications; D014184:Transplantation, Homologous