title: Indication and management of allogeneic stem cell transplantation in primary myelofibrosis: a consensus process by an EBMT/ELN international working group.
abstract: The aim of this work is to produce recommendations on the management of allogeneic stem cell transplantation (allo-SCT) in primary myelofibrosis (PMF). A comprehensive systematic review of articles released from 1999 to 2015 (January) was used as a source of scientific evidence. Recommendations were produced using a Delphi process involving a panel of 23 experts appointed by the European LeukemiaNet and European Blood and Marrow Transplantation Group. Key questions included patient selection, donor selection, pre-transplant management, conditioning regimen, post-transplant management, prevention and management of relapse after transplant. Patients with intermediate-2- or high-risk disease and age <70 years should be considered as candidates for allo-SCT. Patients with intermediate-1-risk disease and age <65 years should be considered as candidates if they present with either refractory, transfusion-dependent anemia, or a percentage of blasts in peripheral blood (PB) >2%, or adverse cytogenetics. Pre-transplant splenectomy should be decided on a case by case basis. Patients with intermediate-2- or high-risk disease lacking an human leukocyte antigen (HLA)-matched sibling or unrelated donor, should be enrolled in a protocol using HLA non-identical donors. PB was considered the most appropriate source of hematopoietic stem cells for HLA-matched sibling and unrelated donor transplants. The optimal intensity of the conditioning regimen still needs to be defined. Strategies such as discontinuation of immune-suppressive drugs, donor lymphocyte infusion or both were deemed appropriate to avoid clinical relapse. In conclusion, we provided consensus-based recommendations aimed to optimize allo-SCT in PMF. Unmet clinical needs were highlighted.
authors: Department of Stem Cell Transplantation, University Hospital, Hamburg, Germany.
authors: N M
authors: NM
authors: Kröger
authors: Clinical Research Division, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, WA, USA.
authors: J H
authors: JH
authors: Deeg
authors: Department of Hematology, Hospital of Navarra, Navarra Health Service, Pamplona, Spain.
authors: E
authors: E
authors: Olavarria
authors: Department of Haematology, Clinical Oncology and Hemostasiology, University of Leipzig, Leipzig, Germany.
authors: D
authors: D
authors: Niederwieser
authors: Ospedale San Martino, Genoa, Italy.
authors: A
authors: A
authors: Bacigalupo
authors: Research Foundation, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors: T
authors: T
authors: Barbui
authors: Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
authors: A
authors: A
authors: Rambaldi
authors: Division of Hematology and Oncology, Mayo Clinic, Scottsdale, AZ, USA.
authors: R
authors: R
authors: Mesa
authors: Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
authors: A
authors: A
authors: Tefferi
authors: Academic Department of Hematology and Oncology, Johannes Wesling Teaching Hospital, Hans-Nolte-Strasse 1, Minden, Germany.
authors: M
authors: M
authors: Griesshammer
authors: Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada.
authors: V
authors: V
authors: Gupta
authors: Department of Haematology Guy's and St Thomas' NHS Foundation Trust, London, UK.
authors: C
authors: C
authors: Harrison
authors: Department of Stem Cell Transplantation, University Hospital, Hamburg, Germany.
authors: H
authors: H
authors: Alchalby
authors: Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
authors: A M
authors: AM
authors: Vannucchi
authors: Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
authors: F
authors: F
authors: Cervantes
authors: Department of Hematology and Bone Marrow Transplantation, Saint Louis Hospital, Paris, France.
authors: M
authors: M
authors: Robin
authors: Department of Bone Marrow Transplantation, WTZ, Comprehensive Cancer Centre, University Hospital Essen, Essen, Germany.
authors: M
authors: M
authors: Ditschkowski
authors: Mayo Clinic Cancer Center, Scottsdale, AZ, USA.
authors: V
authors: V
authors: Fauble
authors: Department of Haematology Guy's and St Thomas' NHS Foundation Trust, London, UK.|Department of Haematological Medicine, King's College Hospital, London, UK.
authors: D
authors: D
authors: McLornan
authors: Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA, USA.
authors: K
authors: K
authors: Ballen
authors: Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors: U R
authors: UR
authors: Popat
authors: Division of Hematology, Department of Medicine, University Hospital Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
authors: F
authors: F
authors: Passamonti
authors: University of Illinois Hospital & Health Sciences System and University of Illinois Cancer Center, Chicago, IL, USA.
authors: D
authors: D
authors: Rondelli
authors: Center for the Study of Myelofibrosis, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
authors: G
authors: G
authors: Barosi
mesh_terms: D046148:Donor Selection; D018380:Hematopoietic Stem Cell Transplantation; D006650:Histocompatibility Testing; D006801:Humans; D055728:Primary Myelofibrosis / Q000401:mortality / Q000628:therapy*; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous