Allogeneic hemopoietic SCT for patients with primary myelofibrosis: a predictive transplant score based on transfusion requirement, spleen size and donor type.
A total of 46 patients with primary myelofibrosis (PMF) (median age 51 years), underwent an allogeneic hemopoietic SCT (HSCT) after a thiotepa-based reduced-intensity conditioning regimen. The median follow-up for surviving patients is 3.8 years. In multivariate analysis, independent unfavorable factors for survival were RBC transfusions >20, a spleen size >22 cm and an alternative donor-24 patients had 0-1 unfavorable predictors (low risk) and 22 patients had 2 or more negative predictors (high risk). The overall actuarial 5-year survival of the 46 patients is 45%. The actuarial survival of low-risk and high-risk patients is, respectively, 77 and 8% (P<0.0001); this is because of a higher TRM for high-risk patients (RR, 6.0, P=0.006) and a higher relapse-related death (RR, 7.69; P=0.001). In multivariate Cox analysis, the score maintained its predictive value (P=0.0003), even after correcting for donor-patient age and gender, Dupriez score, IPSS (International Prognostic Scoring System) score pre-transplant and splenectomy. In conclusion, PMF patients undergoing an allogeneic HSCT may be scored according to the spleen size, transfusion history and donor type; this scoring system may be useful to discuss transplant strategies.
Bacigalupo
A
A
Divisione Ematologia e Trapianto di Midollo Ospedale San Martino, Genova, Italy. andrea.bacigalupo@hsanmartino.it
Soraru
M
M
Dominietto
A
A
Pozzi
S
S
Geroldi
S
S
Van Lint
M T
MT
Ibatici
A
A
Raiola
A M
AM
Frassoni
F
F
De Stefano
F
F
Verdiani
S
S
Casarino
L
L
Barosi
G
G
D000328:Adult; D000368:Aged; D001803:Blood Transfusion; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055728:Primary Myelofibrosis / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D016016:Proportional Hazards Models; D013154:Spleen / Q000473:pathology; D013156:Splenectomy; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D055815:Young Adult