title: Allogeneic hematopoietic stem cell transplantation in myelofibrosis: the 20-year experience of the Gruppo Italiano Trapianto di Midollo Osseo (GITMO).
abstract: BACKGROUND
  Allogeneic stem cell transplantation is a potentially curative treatment for myelofibrosis, although its use is limited by a high rate of transplant-related mortality. In this study, we evaluated the outcome of patients with myelofibrosis who underwent allogeneic stem cell transplantation, and the impact of prognostic factors.
  
  
  METHODS
  One hundred patients were transplanted in 26 Italian centers between 1986 and 2006. We analyzed the influence of the patients' characteristics and the clinical features of their disease before stem cell transplantation and of transplant procedures on transplant-related mortality, overall survival, and relapse-free survival by means of univariate and multivariate analyses.
  
  
  RESULTS
  The median age of the patients at the time of stem cell transplantation was 49 years (range, 21-68) and 90% of them had an intermediate or high Dupriez score. Forty-eight percent received a myeloablative conditioning regimen and 78% received stem cells from matched sibling donors. The cumulative incidence of engraftment at day 90 after transplant was 87% (95% CI, 0.87-0.97). The cumulative 1-year and 3-year incidences of transplant-related mortality were 35% and 43%, respectively. The estimated 3-year overall and relapse-free survival rates after stem cell transplantation were 42% and 35%, respectively. In multivariate analysis, negative predictors of transplant-related mortality were year of stem cell transplantation before 1995, unrelated donor, and a long interval between diagnosis and transplantation. There was a trend towards longer overall and relapse-free survival in patients receiving peripheral blood stem cells rather than bone marrow as the source of their graft (p=0.070 and p=0.077, respectively). The intensity of the conditioning regimen (myeloablative versus reduced intensity regimens) did not significantly influence the outcome.
  
  
  CONCLUSIONS
  We conclude that the outcome of myelofibrosis patients who underwent allogeneic stem cell transplantation significantly improved after 1996 due to the reduction in transplant-related mortality. We observed that a reduction in transplant-related mortality was associated with the choice of a matched sibling donor, whereas longer overall survival was associated with the use of peripheral blood as the source of stem cells.
authors: Division of Hematology and Cellular Therapies Unit Carlo Melzi, Department of Morphological and Medical Research, University of Udine, Udine, Italy. patriarca.francesca@aoud.sanita.fvg.it
authors: Francesca
authors: F
authors: Patriarca
authors: Andrea
authors: A
authors: Bacigalupo
authors: Alessandra
authors: A
authors: Sperotto
authors: Miriam
authors: M
authors: Isola
authors: Franca
authors: F
authors: Soldano
authors: Barbara
authors: B
authors: Bruno
authors: Maria Teresa
authors: MT
authors: van Lint
authors: Anna Paola
authors: AP
authors: Iori
authors: Stella
authors: S
authors: Santarone
authors: Ferdinando
authors: F
authors: Porretto
authors: Pietro
authors: P
authors: Pioltelli
authors: Giuseppe
authors: G
authors: Visani
authors: Pasquale
authors: P
authors: Iacopino
authors: Renato
authors: R
authors: Fanin
authors: Alberto
authors: A
authors: Bosi
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D055728:Primary Myelofibrosis / Q000453:epidemiology / Q000276:immunology / Q000601:surgery; D012008:Recurrence; D013997:Time Factors; D014184:Transplantation, Homologous / Q000276:immunology; D016896:Treatment Outcome