Therapeutic management of patients with primary or secondary myelofibrosis (MF) who experience relapse or graft failure following allogeneic haematopoietic cell transplantation (allo-HCT) remains heterogeneous. We retrospectively analyzed 216 patients undergoing a second allo-HCT for either relapse (56%) or graft failure (31%) between 2010 and 2017. Median age was 57.3 years (range 51-63). The same donor as for the first allo-HCT was chosen in 66 patients (31%) of whom 19 received an HLA-identical sibling donor, whereas a different donor was chosen for 116 patients (54%). Median follow-up was 40 months. Three-year overall survival (OS) and relapse-free survival (RFS) were 42% and 39%, respectively. Three-year non-relapse mortality (NRM) and relapse rates were 36% and 25%, respectively. Grade II-IV and III-IV acute GVHD occurred in 25% and 11% of patients, respectively, and the 3-year incidence of chronic GVHD was 33% including 14% for extensive grade. Graft-failure incidence at 1 year was 14%. In conclusion, our data suggest that a second allo-HCT is a potential option for patients failing first allo-HCT for MF albeit careful patient assessment is fundamental to identify individual patients who could benefit from this approach.

Bone Marrow Transplant Unit Copenhagen Denmark

Bristol Royal Hospital for Children Bristol UK

CHU de Lille univ Lille INSERM U1286 INFINITE 59000 Lille France

Cliniques Universitaires St Luc Brussels Belgium

Department of Biomedical Data Sciences Leiden University Medical Center Leiden the Netherlands

Department of Haematology Guy's and St Thomas' NHS Foundation Trust London UK

Department of Haematology Trinity College Dublin St James's Hospital Dublin Ireland

Department of Hematology and Cellular Therapy University Hospital of Leipzig Leipzig Germany

Department of Hematology Hospital Clínico Universitario Valencia Spain

Division of Hematology Hôpitaux Universitaires De Genève and Faculty of Medicine University of Geneva Geneva Switzerland

EBMT Data Office Leiden the Netherlands

EBMT Statistical Unit Date Office Leiden the Netherlands

Ematologia e Centro Trapianti IRCCS Ospedale Policlinico San Martino Genova Italy

H SS Antonio e Biagio Alessandria Italy

Hôpital Saint Louis APHP Université Paris 7 Paris France

Maria Skłodowska Curie Institute Cancer Center Gliwice Branch Gliwice Poland

Ospedale San Raffaele Milano Italy

Universitaetsklinikum Dresden Dresden Germany

University Hospital Basel Switzerland

University Hospital Brno Brno Czech Republic

University Hospital Eppendorf Hamburg Germany

University of Heidelberg Heidelberg Germany

University of Milan and Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII Bergamo Italy

University of Muenster Muenster Germany

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