We performed a retrospective assessment of patient- and transplant-specific characteristics and outcomes for 4142 patients undergoing allogeneic haematopoietic cell transplant for myelofibrosis between 1995 and 2018 across 278 centres. Activity increased steadily across the four analysed eras (<2006, 2006-2010, 2011-2014 and 2015-2018). Median recipient age increased over time between the earliest and most recent cohort (49.4 years (range, 20.1-68) versus 59.3 years (range, 18.1-78.1). Increasing number of patients with a Karnofsky performance status <90 underwent transplant over time. Increased utilisation of matched unrelated donors was apparent (<2006, 22.5% versus 2015-18, 45.2%; p < 0.001). Decreased use of myeloablative conditioning, increased use of busulphan-based platforms and anti-thymocyte globulin was evident. Of note, rates of acute (a)GVHD grade II-IV by day +100 decreased over time (p = 0.027) as did rates of chronic (c) GVHD, predominantly extensive cGVHD (<2006, 36% (31-41%) versus 2015-18, 23% (21-25%); p = 0.001). Overall, significant factors associated with worse overall survival and non-relapse mortality (NRM) remained older age, use of donors other than matched sibling, recipient CMV seropositivity and a lower Karnofsky performance status (<90). Multivariable analysis demonstrated improvements in overall survival and reductions in relapse risk over time with stable NRM rates despite increasing numbers of older, less fit patients and use of unrelated donors.

Centre Hospitalier Régional Universitaire de Lille Hospital Claude Huriez Huriez France

Charité Universitätsmedizin Berlin Berlin Germany

CHU Nantes Nantes France

Department of Haematology and Stem Cell Transplant Beatson Centre Glasgow Scotland

Department of Haematology Erasmus MC Daniel den Hoed Cancer Center Rottrdam The Netherlands

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

Department of Haematology Military Medical Academy Belgrade Serbia

Department of Haematology St James Hospital Dublin Ireland

Department of Hematology and Stem Cell Transplantation West German Cancer Center University Hospital Essen Essen Germany

Department of Medical Statistics Leiden University Medical Centre Leiden The Netherlands

Division of Stem Cell Transplantation University Hospital Eppendorf Hamburg Germany

EBMT Data Office Leiden The Netherlands

Hematologia and Transplant Center IRCCS Ospedale Policlinico San Martino Genova Italy

Hôpital Saint Louis Service d'Hématologie Greffe Assistance Publique Hôpitaux de Paris Paris France

Hospital Clínico Universitario de Valencia Valencia Spain

Hospital Universitario 12 de Octubre Avd de Cordoba s n Madrid Spain

HUCH Comprehensive Cancer Center Helsinki Finland

Institute of Hematology and Blood Transfusion Prague Czech Republic

Klinik für Hämatologie Bereich Innere Medizin Universitätsspital Basel Basel Switzerland

Maria Sklodowska Curie Memorial Cencer Center and Institute of Oncology Gliwice Branch Gliwice Poland

Service des Maladies du Sang CHRU de Lille LIRIC INSERM U995 Universite de Lille Lille France

Universitaetsklinikum Dresden Dresden Germany

University Hospital Leipzig Leipzig Germany

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