Journal
BONE MARROW TRANSPLANTATION
Volume 32, Issue 1, Pages 35-40Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/sj.bmt.1704075
Keywords
stem cell transplant; allogeneic; myelofibrosis; agnogenic myeloid metaplasia; essential thrombocytosis; graft-versus-host disease; transfusion requirements
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We describe the course of 25 patients with myelofibrosis (MF) due to agnogenic myeloid metaplasia (n = 19) or essential thrombocytosis (n = 6) who underwent allogeneic stem cell transplantation (SCT) at one of two Canadian centers. The median age at transplantation was 48.7 (IQR 45.9-50.4) years and transplantation was carried out at a median of 10.7 (IQR 5.67-26.5) months after diagnosis. Granulocyte engraftment (absolute neutrophil count >0.5 x 10(9)/l) occurred at a median of 20 days after transplantation for splenectomized patients, compared with 27.5 days for nonsplenectomized individuals (P = 0.03). Increased risk of grade II-IV acute graft-versus-host disease (P = 0.04) was noted in patients transplanted after splenectomy. Patients with MF received 0.264+/-0.189 U of packed red blood cells per day over the first 180 days after transplantation, and remained dependent on red blood cell transfusions for a median of 123 (IQR 48-205) days. Complete remission of MF was documented in 33% of evaluable patients. The 1 year cumulative nonrelapse mortality was 48.3%. Median survival for this group of patients was 393 (IQR 109-1014 +) days, with a projected 2-year overall survival of 41%. We conclude that allogeneic SCT offers a reasonable chance for prolonged survival in patients with advanced MF, but this occurs at the cost of considerable toxicity and nonrelapse mortality.
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