title: Allogeneic hematopoietic stem-cell transplantation with reduced-intensity conditioning in intermediate- or high-risk patients with myelofibrosis with myeloid metaplasia.
abstract: A total of 21 patients with myelofibrosis with myeloid metaplasia (MMM), with a median age of 54 years (range, 27-68 years), were prepared with a reduced-intensity conditioning (RIC) regimen. The patients received an allogeneic marrow (n = 3) or peripheral blood stem-cell (n = 18) transplant from HLA-matched related (n = 18) or unrelated (n = 2), or 1 Ag-mismatched related (n = 1), donors. RIC regimens included fludarabine/total body irradiation 200 cGy (n = 5) or 450 cGy (n = 1), fludarabine/melphalan (n = 7), thiotepa/cyclophosphamide (n = 7), and thiotepa/fludarabine (n = 1). At the time of transplantation, all of the patients were at intermediate (n = 13) or high (n = 8) risk, according to the Dupriez classification. Of the patients, 19 had grade III or IV marrow fibrosis. All of the patients achieved full engraftment but one. Posttransplantation chimerism analysis showed more than 95% donor cells in 18 patients, while 2 patients achieved complete donor chimerism after donor leukocyte infusion (DLI). Acute graft-versus-host disease (GVHD) grades II to IV was observed in 7 patients, grades III to IV in 2, and extensive chronic GVHD in 8 of 18 evaluable patients. There were 3 patients who died from acute GVHD, infection, and relapse. There are 18 patients alive 12 to 122 months (median, 31 months) after transplantation, and 17 are in remission (1 after a second transplantation). The use of RIC regimens in allogeneic stem cell transplantation results in prolonged survival in intermediate/high-risk MMM patients.
authors.affiliation: Stem Cell Transplant Program, Section Hematology/Oncology, University of Illinois at Chicago, 900 S Ashland Ave, Chicago, IL 60607-7171, USA. drond@uic.edu
authors.forename: Damiano
authors.initials: D
authors.lastname: Rondelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barosi
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Josef T
authors.initials: JT
authors.lastname: Prchal
authors.forename: Uday
authors.initials: U
authors.lastname: Popat
authors.forename: Emilio P
authors.initials: EP
authors.lastname: Alessandrino
authors.forename: Jerry L
authors.initials: JL
authors.lastname: Spivak
authors.forename: B Douglas
authors.initials: BD
authors.lastname: Smith
authors.forename: Hans G
authors.initials: HG
authors.lastname: Klingemann
authors.forename: Steven
authors.initials: S
authors.lastname: Fruchtman
authors.forename: Ronald
authors.initials: R
authors.lastname: Hoffman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D055728:Primary Myelofibrosis / Q000150:complications* / Q000276:immunology / Q000601:surgery / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous