Outcomes Following Second Allogenic Haematopoietic Cell Transplantation in Patients with Myelofibrosis: A Retrospective Study on Behalf of the Chronic Malignancies Working Party of EBMT in Blood
2019
AOU Alessandria
Tipo pubblicazione
Conference Abstract
Autori/Collaboratori (25)Vedi tutti...
Kröger N
University Hospital Eppendorf, Hamburg, Germany
Angelucci E
Unita Operativa Ematologia Ospedale ‘A. Businco‘, Genova, Italy
Wang J
EBMT Statistical Unit, Leiden, Netherlands
et alii...
Abstract
Introduction: The only curative treatment for myelofibrosis (MF) remains allogenic haematopoietic cell transplantation (allo-HCT) although the risks of non-relapse mortality (NRM), relapse and graft rejection need to be taken into consideration. Therapeutic approaches following relapse after allo-HCT include symptom-directed management, chemotherapy, JAK2 inhibitors, adoptive immunotherapeutic approaches with donor lymphocyte infusion (DLI) and, in a minority, a second allo-HCT. Frequently, due to the advanced age of the recipient, early relapses, and numerous complications, 2nd allo-HCT can only be considered in a limited number of patients. Few studies evaluating the role of 2nd allo-HCT in MF following 1st relapse or primary/secondary graft rejection have been published to date. Methods and results: Patient selection was performed by identifying adult patients who underwent 2nd allo-HCT for MF between 2010-2017: 216 patients were analyzed; 64% were male, 78% had primary MF (PMF) and 22% secondary MF (sMF). Median age at the time of 2nd allo-HCT was 57 years, and median time from 1st allo-HCT was 8 months. Of this cohort, 56% of patients received a 2nd allo-HCT for relapse, 31% for graft failure and the reason was missing in 13%. A greater proportion was transplanted within 1 year from 1st allo-HCT (61 %) whilst 39% had 2nd allo-HCT > 1 year. A reduced Karnofsky performance status (KPS<90) was noted in 50% of patients. Conditioning regimens were reduced-intensity (RIC) in 72% and myeloablative (MAC) in 19% of patients, respectively. Donors were related in 38% and unrelated in 62%. T-cell depletion was reported in 46% of patients. In 31% of patients, the same donor as utilized for the first allo-HCT episode was recruited, whilst an alternative donor was utilized in 54% of cases. Sustained engraftment was achieved in 69% of the cohort, with a significant proportion of patients experiencing either primary (13%) or secondary (12%) graft failure, details were la
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DOI : 10.1182/blood-2019-125802
Keywords
cancer recurrence; cancer patient; allogeneic hematopoietic stem cell transplantation; adult; advisory committee; cancer survival; clustered regularly interspaced short palindromic repeat; cohort analysis; conference abstract; controlled study; cumulative incidence; female; follow up; funding; gender; graft failure; graft versus host reaction; human; Karnofsky Performance Status; major clinical study; male; malignant neoplasm; mortality; myeloid metaplasia; overall survival; patient selection; recurrence free survival; relapse; remote ischemic conditioning; retrospective study; risk factor; T cell depletion; travel; treatment failure; univariate analysis;