Safety and outcome of allogeneic stem cell transplantation in myelofibrosis

Medientyp: E-Artikel
Titel: Safety and outcome of allogeneic stem cell transplantation in myelofibrosis
Beteiligte: Markiewicz, Miroslaw; Dzierzak Mietla, Monika; Wieczorkiewicz, Agata; Mizia, Sylwia; Helbig, Grzegorz; Kopera, Malgorzata; Bialas, Krzysztof; Rybicka, Malwina; Matyja, Mariusz; Koclega, Anna; Sedlak, Lech; Oleksy, Tomasz; Raman, Sundar; Kyrcz‐Krzemien, Slawomira
Erschienen: Wiley, 2016
Erschienen in: European Journal of Haematology
Sprache: Englisch
DOI: 10.1111/ejh.12572
ISSN: 1600-0609; 0902-4441
Schlagwörter: Hematology ; General Medicine
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Beschreibung: <jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>We evaluated the safety and outcome of allo‐<jats:styled-content style="fixed-case">HSCT</jats:styled-content>s in myelofibrosis (<jats:styled-content style="fixed-case">MF</jats:styled-content>).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A total of 27 patients with primary (<jats:italic>n</jats:italic> = 20) or secondary (<jats:italic>n</jats:italic> = 7) <jats:styled-content style="fixed-case">MF</jats:styled-content>, aged 51 (21–63) yr, transplanted from <jats:styled-content style="fixed-case">HLA</jats:styled-content>‐matched related (59%) or unrelated (41%) donors were analyzed. Conditioning was reduced in 26 and myeloablative in one patient; and <jats:styled-content style="fixed-case">ATG</jats:styled-content> was used in 25. Sources of stem cells were as follows: peripheral blood (21), bone marrow (4) or both (2).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Prognostic factors that adversely affected overall survival (<jats:styled-content style="fixed-case">OS</jats:styled-content>) in the multivariate analysis were as follows: recipient age >45 yr (<jats:styled-content style="fixed-case">HR</jats:styled-content> = 10.55, <jats:italic>P</jats:italic> = 0.025) and unrelated donor (<jats:styled-content style="fixed-case">HR</jats:styled-content>=3.73, <jats:italic>P</jats:italic> = 0.026). Post‐transplant transfusion dependence adversely affected <jats:styled-content style="fixed-case">OS</jats:styled-content> in the univariate analysis: dependence from either both <jats:styled-content style="fixed-case">RBC</jats:styled-content>s and platelets (<jats:styled-content style="fixed-case">HR</jats:styled-content> = 33.26, <jats:italic>P</jats:italic> = 0.001) or from either of them (<jats:styled-content style="fixed-case">HR</jats:styled-content> = 10.53, <jats:italic>P</jats:italic> = 0.043). Of 16 <jats:italic><jats:styled-content style="fixed-case">JAK</jats:styled-content>2</jats:italic>V617F‐positive patients evaluated post‐transplant, it was eradicated in 69% and decreased in 25%. Acute <jats:styled-content style="fixed-case">GVHD III</jats:styled-content>‐<jats:styled-content style="fixed-case">IV</jats:styled-content> developed in 19% and extensive chronic <jats:styled-content style="fixed-case">GVHD</jats:styled-content> in 26% of patients; the relapse in four patients was treated with second allo‐<jats:styled-content style="fixed-case">HSCT</jats:styled-content>. Spleen decreased in all evaluated patients (<jats:italic>n</jats:italic> = 24). Fibrotic changes improved or disappeared in 80% of evaluated patients (<jats:italic>n</jats:italic> = 10).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Allo‐<jats:styled-content style="fixed-case">HSCT</jats:styled-content> may prolong survival, provide disease regression and improve quality of life in <jats:styled-content style="fixed-case">MF</jats:styled-content>, especially in patients ≤45 yr transplanted from matched related donors. Achieving transfusion independence post‐transplant indicates the favorable outcome.</jats:p></jats:sec>

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