title: Improved Outcome of Alternative Donor Transplantations in Patients with Myelofibrosis: From Unrelated to Haploidentical Family Donors.
abstract: This is a retrospective analysis of 95 patients with myelofibrosis who were allografted between 2001 and 2014. The aims of the study were to assess whether the outcome of alternative donor grafts has improved with time and how this compares with the outcome of identical sibling grafts. Patients were studied in 2 time intervals: 2000 to 2010 (n = 58) and 2011 to 2014 (n = 37). The Dynamic International Prognostic Scoring System score was comparable in the 2 time periods, but differences in the most recent group included older age (58 versus 53 years, P = .004), more family haploidentical donors (54% versus 5%, P < .0001), and the introduction of the thiotepa-fludarabine-busulfan conditioning regimen (70% of patients versus 2%, P < .0001). Acute and chronic graft-versus-host disease were comparable in the 2 time periods. The 3-year transplantation-related mortality (TRM) in the 2011 to 2014 period versus the 2000 to 2010 period is 16% versus 32% (P = .10), the relapse rate 16% versus 40% (P = .06), and actuarial survival 70% versus 39% (P = .08). Improved survival was most pronounced in alternative donor grafts (69% versus 21%, P = .02), compared with matched sibling grafts (72% versus 45%, P = .40). In conclusion, the outcome of allografts in patients with myelofibrosis has improved in recent years because of a reduction of both TRM and relapse. Improvement is most significant in alternative donor transplantations, with modifications in donor type and conditioning regimen.
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Bregante
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Alida
authors.initials: A
authors.lastname: Dominietto
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Ghiso
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Raiola
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Gualandi
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Varaldo
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Carmen
authors.initials: C
authors.lastname: Di Grazia
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Lamparelli
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Luchetti
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Geroldi
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Casarino
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Sarah
authors.initials: S
authors.lastname: Pozzi
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Tedone
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Van Lint
authors.affiliation: Divisione Ematologia e Trapianto di Midollo, IRCCS AOU San Martino-IST, Genova, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Galaverna
authors.affiliation: Unita' di Epidemiologia Clinica -Centro per lo studio della Mielofibrosi, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Barosi
authors.affiliation: Istituto di Ematologia, Universita' Cattolica del Sacro Cuore, Fondazione Policlinico A Gemelli, Roma, Italy. Electronic address: apbacigalupo@yahoo.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055728:Primary Myelofibrosis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods*; D016896:Treatment Outcome; D061349:Unrelated Donors; D055815:Young Adult
keywords: Haploidentical donors; Myelofibrosis; Unrelated donors