title: Allogeneic stem cell transplantation for myeloproliferative neoplasm in blast phase.
abstract: The prognosis for patients with Philadelphia-negative myeloproliferative neoplasms (MPN) who evolve into acute myeloid leukemia (AML) or blast phase (MPN-BP) is extremely poor. Although allogeneic stem cell transplantation (allo-SCT) is considered potentially curative, very few patients have been reported who have undergone allo-SCT for MPN-BP; therefore the success rate remains unknown. In a retrospective review, we identified 13 patients with an MPN transformation to blast phase after a median 9 years (range 5 months to 30 years); 8 (median age 55) continued to allo-SCT within 6 months. Induction chemotherapy cleared blood/marrow blasts in 60% (6/10) (2 declined therapy, 1 had early death). At the time of allo-SCT, 5/8 patients were in complete remission (CR) of their leukemia or had returned to MPN chronic phase (CP), 2 had residual blood blasts and 1 was refractory with >5% marrow blasts. At follow-up (median 20.3 months), 6 patients are alive in CR of both their leukemia/MPN. All 5 patients in CR/CP at pre-allo-SCT remain alive in remission, while 2/3 with persistent blood/marrow blasts relapsed and expired. We conclude that MPN-BP can be cured by allo-SCT in a significant percentage of patients, but that adequate leukemic clearance prior to allo-SCT offers an optimal outcome.
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ 85259, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Cherington
authors.forename: James L
authors.initials: JL
authors.lastname: Slack
authors.forename: Jose
authors.initials: J
authors.lastname: Leis
authors.forename: Roberta H
authors.initials: RH
authors.lastname: Adams
authors.forename: Craig B
authors.initials: CB
authors.lastname: Reeder
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Mikhael
authors.forename: John
authors.initials: J
authors.lastname: Camoriano
authors.forename: Pierre
authors.initials: P
authors.lastname: Noel
authors.forename: Veena
authors.initials: V
authors.lastname: Fauble
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Betcher
authors.forename: Meagan S
authors.initials: MS
authors.lastname: Higgins
authors.forename: Ginger
authors.initials: G
authors.lastname: Gillette-Kent
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Tremblay
authors.forename: Mary E
authors.initials: ME
authors.lastname: Peterson
authors.forename: Jane J
authors.initials: JJ
authors.lastname: Olsen
authors.forename: Raoul
authors.initials: R
authors.lastname: Tibes
authors.forename: Ruben A
authors.initials: RA
authors.lastname: Mesa
mesh_terms: D000328:Adult; D000368:Aged; D001752:Blast Crisis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009196:Myeloproliferative Disorders / Q000175:diagnosis / Q000235:genetics / Q000473:pathology* / Q000628:therapy*; D012074:Remission Induction; D012189:Retrospective Studies; D033581:Stem Cell Transplantation / Q000379:methods*; D014184:Transplantation, Homologous; D016896:Treatment Outcome