Australasian Trends in Allogeneic Stem Cell Transplantation for Myelofibrosis in the Molecular Era: A Retrospective Analysis from the Australasian Bone Marrow Transplant Recipient Registry.

Autor: Lwin Y; Department of Haematology and Bone Marrow Transplantation, St Vincent's Hospital, Sydney, Australia. Electronic address: yadanarlwin@gmail.com., Kennedy G; Department of Haematology and Bone Marrow Transplantation, Royal Brisbane and Women's Hospital, Brisbane, Australia; University of Queensland, St Lucia, Australia., Gottlieb D; Department of Haematology and Bone Marrow Transplantation, Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia., Kwan J; Department of Haematology and Bone Marrow Transplantation, Westmead Hospital, Sydney, Australia; University of Sydney, Sydney, Australia., Ritchie D; Department of Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; University of Melbourne, Melbourne, Australia., Szer J; Department of Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; University of Melbourne, Melbourne, Australia., Milliken S; Department of Haematology and Bone Marrow Transplantation, St Vincent's Hospital, Sydney, Australia., Browett P; University of Auckland, Auckland, New Zealand., Spencer A; Department of Haematology and Stem Cell Transplantation, The Alfred Hospital, Melbourne, Australia., Butler A; Department of Haematology, Christchurch Hospital, Christchurch, New Zealand., Bardy P; Department of Haematology, Royal Adelaide Hospital, Adelaide, Australia., Greenwood M; University of Sydney, Sydney, Australia; Department of Haematology and Bone Marrow Transplantation, Royal North Shore Hospital, Sydney, Australia., Perera T; Wellington Blood and Cancer Centre, Wellington, New Zealand., He S; Department of Haematology, Austin Hospital, Melbourne, Australia., McEwan A; Department of Haematology, Liverpool Hospital, Sydney, Australia., Larsen S; Department of Haematology, Royal Prince Alfred Hospital, Sydney, Australia., Lai H; Department of Haematology, Townsville University Hospital, Townsville, Australia., Purtill D; Department of Haematology, Fiona Stanley Hospital, Perth, Australia., Tran S; The Australasian Bone Marrow Transplant Recipient Registry, Sydney, Australia., Aarons D; The Australasian Bone Marrow Transplant Recipient Registry, Sydney, Australia., Hamad N; Department of Haematology and Bone Marrow Transplantation, St Vincent's Hospital, Sydney, Australia; University of New South Wales, Sydney, Australia.
Jazyk: angličtina
Zdroj: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation [Biol Blood Marrow Transplant] 2020 Dec; Vol. 26 (12), pp. 2252-2261. Date of Electronic Publication: 2020 Aug 27.
DOI: 10.1016/j.bbmt.2020.08.024
Abstrakt: To review the updated trends of national practice and outcomes in transplantation to treat myelofibrosis (MF), we retrospectively evaluated 142 patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) for primary (n = 94) or secondary (n = 48) MF at an Australian/New Zealand transplantation center between 2006 and 2017. The median duration of follow-up was 51.8 months (range, 3.1 to 148 months). The median age at allo-HSCT was 56 years (range, 26 to 69 years). Fifty-two percent of the patients had HLA-identical sibling donors, and 45% had matched unrelated donors (UD). Conditioning regimens were predominantly reduced intensity (83%). Before transplantation, 16% of the patients had undergone splenectomy or splenic irradiation, and 38% (n = 54) received JAK inhibitor therapy. JAK2 mutation testing was performed in 66.9% of the patients, whereas other mutations (CALR, MPL, ASXL1, SRSF2, U2AF1Q57, EZH2, and IDH1/2) were rarely tested (1.4% to 8.4%). Only 4.2% of patients had next-generation sequencing mutation analysis. The median time to neutrophil engraftment was 19 days (range, 10 to 43 days), and the median time to platelet engraftment was 27 days (range, 13 to 230 days). The cumulative incidence of grade II-IV acute graft-versus-host disease (aGVHD) was 21.4% at 100 days, and that of extensive chronic GVHD (cGVHD) at 5 years was 18.1%. Overall survival (OS) was 67% at 1 year and 57% at 5 years. GVHD-free, relapse-free survival was 54% at 1 year and 42% at 5 years. The cumulative incidence of nonrelapse mortality (NRM) was 16% at 100 days and 25% at 1 year. In multivariate analysis, age ≥65 years and use of an UD were identified as significant unfavorable risk factors for OS and NRM. Use of an UD increased the incidence of aGVHD, whereas administration of antithymocyte globulin/alemtuzumab lowered the risk of both aGVHD and cGVHD. Pretransplantation splenectomy/splenic irradiation had a positive influence on time to engraftment. There have been no improvements in the outcomes of allo-HSCT for MF in Australasia over the last decade, with a low uptake of molecular genomic technology due to limited access to funding.
(Copyright © 2020 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: