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Family Mismatched Allogeneic Stem Cell Transplantation for Myelofibrosis: Report from the Chronic Malignancies Working Party of European Society for Blood and Marrow Transplantation
K. Raj, DJ. Eikema, DP. McLornan, E. Olavarria, HJ. Blok, S. Bregante, F. Ciceri, J. Passweg, P. Ljungman, N. Schaap, K. Carlson, T. Zuckerman, LC. de Wreede, L. Volin, Y. Koc, JL. Diez-Martin, P. Brossart, D. Wolf, D. Blaise, PD. Bartolomeo, A....
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články
- MeSH
- analýza přežití MeSH
- databáze faktografické MeSH
- dospělí MeSH
- histokompatibilita * MeSH
- homologní transplantace MeSH
- lidé středního věku MeSH
- lidé MeSH
- nemoc štěpu proti hostiteli MeSH
- přežívání štěpu MeSH
- primární myelofibróza mortalita terapie MeSH
- příprava pacienta k transplantaci MeSH
- recidiva MeSH
- retrospektivní studie MeSH
- rodina * MeSH
- senioři MeSH
- společnosti lékařské MeSH
- transplantace hematopoetických kmenových buněk metody MeSH
- transplantace kostní dřeně statistika a číselné údaje MeSH
- transplantace periferních kmenových buněk statistika a číselné údaje MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Evropa MeSH
This analysis included 56 myelofibrosis (MF) patients transplanted from family mismatched donor between 2009 and 2015 enrolled in the European Society for Blood and Marrow Transplantation database. The median age was 57years (range, 38 to 72); 75% had primary MF and 25% had secondary MF. JAK2 V617F was mutated in 61%. Donors were HLA mismatched at 2 or more loci. Stem cells were sourced from bone marrow in 66% and peripheral blood in 34%. The median CD34+ cell dose was 4.8 × 106/kg (range, 1.7 to 22.9; n = 43). Conditioning was predominantly myeloablative in 70% and reduced intensity in the remainder. Regimens were heterogeneous with thiotepa, busulfan, fludarabine, and post-transplant cyclophosphamide used in 59%. The incidence of neutrophil engraftment by 28days was 82% (range, 70% to 93%), at a median of 21days (range, 19 to 23). At 2years the cumulative incidence of primary graft failure was 9% (95% CI 1% to 16%) and secondary graft failure was 13% (95% CI 4% to 22%). The cumulative incidence of acute graft-versus-host disease (GVHD) grades II to IV and III to IV was 28% (95% CI 16% to 40%) and 9% (95% CI 2% to 17%) at 100days. The cumulative incidence of chronic GVHD at 1 year was 45% (95% CI 32% to 58%), but the cumulative incidence of death without chronic GVHD by 1 year was 20% (95% CI 10% to 31%). With a median follow-up of 32 months, the 1- and 2-year overall survival was 61% (95% CI 48% to 74%) and 56% (95% CI 41% to 70%), respectively. The 1- and 2- year progression-free survival was 58% (95% CI 45% to 71%) and 43% (95% CI 28% to 58%), respectively, with a 2-year cumulative incidence of relapse of 19% (95% CI 7% to 31%). The 2-year nonrelapse mortality was 38% (95% CI 24% to 51%). This retrospective study of MF allo-SCT using family mismatched donors demonstrated feasibility of the approach, timely neutrophil engraftment in over 80% of cases, and acceptable overall and progression-free survival rates with relapse rates not dissimilar to the unrelated donor setting. However, strategies to minimize the risk of graft failure and the relatively high nonrelapse mortality need to be used, ideally in a multicenter prospective fashion.
Department of Haematological Medicine Hammersmith Hospital London United Kingdom
Department of Haematology Ospedale San Martino Genova Italy
Department of Hematology and Bone marrow transplantation Hopital St Louis Paris France
Department of Hematology Lille University hospital INSERM U995 Universite de Lille France
Department of Hematology Radboud University Medical Centre Nijmegen The Netherlands
Department of Hematology Transfusion Medicine and Biotechnology Ospedale Civile Pescara Italy
Department of Internal Medicine University Hospital Basel Switzerland
Department of Medical Statistics and Bioinformatics EBMT Statistical Unit Leiden The Netherlands
Department of Oncology Stem cell transplant unit Medical Park Hospitals Antalya Turkey
Department of Stem Cell Transplantation University Hospital Eppendorf Hamburg Germany
Departmetn of Immuno oncolgy and Rheumatology Universitat Bonn Bonn Germany
Depatment of Hematology and Bone marrow Transplantation Rambam Medical Center Haifa Israel
Deutsche Knochenmarkspenderdatei Clinical Trials Unit Dresden Germany
Division of Hematology Karolinska University Hospital Stockholm Sweden
Institute of Hematology and Blood Transfusion Prague Czech Rep
Internal Medicine Hematology University Hospital Uppsala Sweden
Citace poskytuje Crossref.org
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- $a Raj, Kavita $u Department of Haematological Medicine,Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom. Electronic address: kavitaraj28@gmail.com.
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- $a This analysis included 56 myelofibrosis (MF) patients transplanted from family mismatched donor between 2009 and 2015 enrolled in the European Society for Blood and Marrow Transplantation database. The median age was 57years (range, 38 to 72); 75% had primary MF and 25% had secondary MF. JAK2 V617F was mutated in 61%. Donors were HLA mismatched at 2 or more loci. Stem cells were sourced from bone marrow in 66% and peripheral blood in 34%. The median CD34+ cell dose was 4.8 × 106/kg (range, 1.7 to 22.9; n = 43). Conditioning was predominantly myeloablative in 70% and reduced intensity in the remainder. Regimens were heterogeneous with thiotepa, busulfan, fludarabine, and post-transplant cyclophosphamide used in 59%. The incidence of neutrophil engraftment by 28days was 82% (range, 70% to 93%), at a median of 21days (range, 19 to 23). At 2years the cumulative incidence of primary graft failure was 9% (95% CI 1% to 16%) and secondary graft failure was 13% (95% CI 4% to 22%). The cumulative incidence of acute graft-versus-host disease (GVHD) grades II to IV and III to IV was 28% (95% CI 16% to 40%) and 9% (95% CI 2% to 17%) at 100days. The cumulative incidence of chronic GVHD at 1 year was 45% (95% CI 32% to 58%), but the cumulative incidence of death without chronic GVHD by 1 year was 20% (95% CI 10% to 31%). With a median follow-up of 32 months, the 1- and 2-year overall survival was 61% (95% CI 48% to 74%) and 56% (95% CI 41% to 70%), respectively. The 1- and 2- year progression-free survival was 58% (95% CI 45% to 71%) and 43% (95% CI 28% to 58%), respectively, with a 2-year cumulative incidence of relapse of 19% (95% CI 7% to 31%). The 2-year nonrelapse mortality was 38% (95% CI 24% to 51%). This retrospective study of MF allo-SCT using family mismatched donors demonstrated feasibility of the approach, timely neutrophil engraftment in over 80% of cases, and acceptable overall and progression-free survival rates with relapse rates not dissimilar to the unrelated donor setting. However, strategies to minimize the risk of graft failure and the relatively high nonrelapse mortality need to be used, ideally in a multicenter prospective fashion.
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- $a Zuckerman, Tsila $u Depatment of Hematology and Bone marrow Transplantation,Rambam Medical Center, Haifa, Israel.
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