Allogeneic stem cell transplantation for myelodysplastic syndromes with bone marrow fibrosis.
BACKGROUND
Bone marrow fibrosis in patients with myelodysplastic syndrome is associated with a poor outcome, but whether the outcome after allogeneic stem cell transplantation is related to the degree of bone marrow fibrosis is unknown.


METHODS
Patients with myelodysplastic syndrome and known bone marrow histology (n=721) who underwent hematopoietic stem cell transplantation were classified according to the degree of bone marrow fibrosis into those without fibrosis (n=483), those with mild or moderate fibrosis (n=199) and those with severe fibrosis (n=39) and analyzed regarding engraftment, treatment-related mortality, relapse and survival.


RESULTS
The degree of fibrosis was not associated with disease status or abnormal cytogenetics. The cumulative incidence of engraftment achieved at day +30 in non-fibrotic patients was 93% and was significantly lower in those with mild or moderate fibrosis (89%) and severe fibrosis (75%) (P=0.009). Neutrophil engraftment occurred later in patients with mild or moderate fibrosis and severe fibrosis than in patients without fibrosis (median 17 versus 20 versus 16 days, respectively; P=0.002). The cumulative incidence of relapse at 3 years was significantly higher in patients with severe fibrosis than in those with a lesser degree of fibrosis or no fibrosis (47% versus 28% versus 27%, respectively; P=0.04), resulting in comparable 3-year disease-free survival rates in patients without fibrosis and in those with mild or moderate fibrosis (42% versus 38%, respectively) but a lower disease-free survival rate in those with severe fibrosis (18%; P=0.002). Severe fibrosis remained an independent factor for reduced survival (hazard ratio, 1.9; P=0.006).


CONCLUSIONS
Among patients with myelodysplastic syndromes, only severe fibrosis affects survival after hematopoietic stem cell transplantation while patients with mild or moderate fibrosis have an outcome comparable to that of patients without bone marrow fibrosis.
Department for Stem Cell Transplantation, University Medical Center, Hamburg-Eppendorf, Martinistraße 52 D-20246, Hamburg, Germany. nkroeger@uke.uni-hamburg.de
Nicolaus
N
Kröger
Tatjana
T
Zabelina
Anja
A
van Biezen
Ronald
R
Brand
Dietger
D
Niederwieser
Rodrigo
R
Martino
Zi Yi
ZY
Lim
Francesco
F
Onida
Christoph
C
Schmid
Laurent
L
Garderet
Marie
M
Robin
Michael
M
van Gelder
Reinhard
R
Marks
Argiris
A
Symeonidis
Guido
G
Kobbe
Theo
T
de Witte
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000401:mortality* / Q000628:therapy; D055728:Primary Myelofibrosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012008:Recurrence; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult