Mediterranean Journal of Hematology and Infectious Diseases (May 2010)

OUTCOME OF ALLOGENEIC STEM CELL TRANSPLANTATION FOLLOWING REDUCED-INTENSITY CONDITIONINIG REGIMEN IN PATIENTS WITH IDIOPATHIC MYELOFIBROSIS: THE G.I.T.M.O. EXPERIENCE AND REVIEW OF THE LITERATURE

  • Miriam Isola,
  • Alessandra Sperotto,
  • Andrea Bacigalupo,
  • Francesca Patriarca,
  • Maria Teresa Van Lint,
  • Anna Paola Iori,
  • Paolo Di Bartolomeo,
  • Maurizio Musso,
  • Pietro Pioltelli,
  • Giuseppe Visani,
  • Pasquale Iacopino,
  • Renato Fanin,
  • Alberto Bosi

Journal volume & issue
Vol. 2, no. 2
pp. e2010010 – e2010010

Abstract

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<p class="MsoBodyText" style="margin: 0cm 0cm 0pt;"><strong style="mso-bidi-font-weight: normal;"><em style="mso-bidi-font-style: normal;"><span style="mso-ansi-language: IT;"><span style="font-size: small;"><span style="font-family: Times New Roman;">Background</span></span></span></em></strong></p><p class="MsoNormal" style="margin: 0cm 0cm 0pt; line-height: 150%; text-align: justify;"><span style="mso-ansi-language: EN-GB;" lang="EN-GB"><span style="font-size: small;"><span style="font-family: Times New Roman;">Allogeneic stem cell transplantation (SCT) is a potentially curative treatment for myelofibrosis (MI), <span style="mso-spacerun: yes;"> </span>though<span style="mso-spacerun: yes;"> </span>limited by a high rate<span style="mso-spacerun: yes;"> </span>of transplant-related mortality (TRM). .<span style="mso-spacerun: yes;"> </span>In the present study we evaluate the outcome of MI patients undergoing an allogeneic SCT after reduced intensity conditioning (RIC) regimens <span style="mso-spacerun: yes;"> </span>, and the impact of prognostic factors . </span></span></span></p><p class="MsoBodyText" style="margin: 0cm 0cm 0pt; line-height: 150%;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong><em><span lang="EN-GB">Design and methods</span></em></strong><span lang="EN-GB">: 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.</span></span></span></p><p class="MsoBodyText" style="margin: 0cm 0cm 0pt; line-height: 150%;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong><em><span lang="EN-GB">Results:</span></em></strong><span lang="EN-GB"> At SCT, <span style="mso-spacerun: yes;"> </span>median age was 52,5 years (32-68) and <span style="mso-spacerun: yes;"> </span>89% of the patients had<span style="mso-spacerun: yes;"> </span>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.<span style="mso-spacerun: yes;"> </span>Stem cells came from matched sibling donors for 75% of the patients and mismatched sibling or unrelated donors for the remaining 25%.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span>The cumulative incidence of engraftment at day 90 after transplant was 83% (95% CI, 0.87-0.97 ). The estimated<span style="mso-spacerun: yes;"> </span>1-year TRM was 30%.<span style="mso-spacerun: yes;"> </span>The estimated<span style="mso-spacerun: yes;"> </span>3- -year event-free-survival (EFS) and OS after hematopoietic SCT was 44% <span style="mso-spacerun: yes;"> </span>and 38% respectively. </span><span style="mso-ansi-language: EN-US; mso-bidi-font-weight: bold;" lang="EN-US"><span style="mso-spacerun: yes;"> </span>In multivariate analysis , an higher leukocyte count and circulating blasts in the peripheral blood before SCT significantly reduced EFS and OS respectively. </span></span></span></p><p class="MsoBodyText" style="margin: 0cm 0cm 0pt; line-height: 150%;"><span style="font-size: small;"><span style="font-family: Times New Roman;"><strong style="mso-bidi-font-weight: normal;"><em style="mso-bidi-font-style: normal;"><span lang="EN-GB">Interpretation and conclusions:</span></em></strong><span lang="EN-GB"> 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</span></span></span></p>

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