title: Outcome of allogeneic stem cell transplantation following reduced-intensity conditioninig regimen in patients with idiopathic myelofibrosis: the g.I.T.m.o. Experience.
abstract: BACKGROUND
  Allogeneic stem cell transplantation (SCT) is a potentially curative treatment for myelofibrosis (MI), though limited by a high rate of transplant-related mortality (TRM). In the present study we evaluate the outcome of MI patients undergoing an allogenic SCT after reduced intensity conditioning (RIC) regimens, and the impact of prognostic factors.
  
  
  METHODS
  Fifty two patients were transplanted in 26 Italian centres between 1998 and 2006. We analyzed the influence of patient and disease clinical features before SCT and of transplant procedures on TRM and overall survival (OS) by means of univariate and multivariate analyses.
  
  
  RESULTS
  At SCT, median age was 52,5 years (32-68) and 89% of the patients had an intermediate or high Dupriez score. Conditioning regimens were based on fludarabine plus busulphan in 27% of patients, thiotepa plus cyclophosphamide in 46% and miscellaneous drug combinations in the other 27% of cases. Stem cells came from matched sibling donors for 75% of the patients and mismatched sibling or unrelated donors for the remaining 25%. The cumulative incidence of engraftment at day 90 after transplant was 83% (95% CI, 0.87-0.97). The estimated 1-year TRM was 30%. The estimated 3-year event-free-survival (EFS) and OS after hematopoietic SCT was 44% and 38% respectively. In multivariate analysis, an higher leukocyte count and circulating blasts in the peripheral blood before SCT significantly reduced EFS and OS respectively.
  
  
  CONCLUSIONS
  We conclude that the extension of the disease before transplantation based on the presence of circulating blasts and high leukocyte counts significantly affected the outcome after HSCT.
authors.affiliation: Division of Hematology and Cellular Therapies Unit 'Carlo Melzi', Dpt. of Morphological and Clinical Researches, University of Udine.
authors.forename: Francesca
authors.initials: F
authors.lastname: Patriarca
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sperotto
authors.forename: Miriam
authors.initials: M
authors.lastname: Isola
authors.forename: Barbara
authors.initials: B
authors.lastname: Bruno
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: van Lint
authors.forename: Anna Paola
authors.initials: AP
authors.lastname: Iori
authors.forename: Paolo
authors.initials: P
authors.lastname: Di Bartolomeo
authors.forename: Maurizio
authors.initials: M
authors.lastname: Musso
authors.forename: Pietro
authors.initials: P
authors.lastname: Pioltelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Visani
authors.forename: Pasquale
authors.initials: P
authors.lastname: Iacopino
authors.forename: Renato
authors.initials: R
authors.lastname: Fanin
authors.forename: Alberto
authors.initials: A
authors.lastname: Bosi