Journal Article

Indication and management of allogeneic stem cell transplantation in primary myelofibrosis: a consensus process by an EBMT/ELN international working group

Alchalby, H, Rondelli, D, Bacigalupo, A, Mesa, R, Vannucchi, A M, Popat, U R, Deeg, J H, Niederwieser, D, Barbui, T, Passamonti, F, Robin, M, McLornan, D, Kröger, N M, Gupta, V, Barosi, G, Olavarria, E, Ballen, K, Harrison, C, Cervantes, F, Ditschkowski, M, Griesshammer, M, Rambaldi, A, Fauble, V, Tefferi, A

2015

Overview

The aim of this work is to produce recommendations on the management of allogeneic stem cell transplantation (allo-SCT) in primary myelofibrosis (PMF). A comprehensive systematic review of articles released from 1999 to 2015 (January) was used as a source of scientific evidence. Recommendations were produced using a Delphi process involving a panel of 23 experts appointed by the European LeukemiaNet and European Blood and Marrow Transplantation Group. Key questions included patient selection, donor selection, pre-transplant management, conditioning regimen, post-transplant management, prevention and management of relapse after transplant. Patients with intermediate-2- or high-risk disease and age <70 years should be considered as candidates for allo-SCT. Patients with intermediate-1-risk disease and age <65 years should be considered as candidates if they present with either refractory, transfusion-dependent anemia, or a percentage of blasts in peripheral blood (PB) >2%, or adverse cytogenetics. Pre-transplant splenectomy should be decided on a case by case basis. Patients with intermediate-2- or high-risk disease lacking an human leukocyte antigen (HLA)-matched sibling or unrelated donor, should be enrolled in a protocol using HLA non-identical donors. PB was considered the most appropriate source of hematopoietic stem cells for HLA-matched sibling and unrelated donor transplants. The optimal intensity of the conditioning regimen still needs to be defined. Strategies such as discontinuation of immune-suppressive drugs, donor lymphocyte infusion or both were deemed appropriate to avoid clinical relapse. In conclusion, we provided consensus-based recommendations aimed to optimize allo-SCT in PMF. Unmet clinical needs were highlighted.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/699/1541/1990/2331 / 692/700/565/2319 / 692/700/565/545/576/1955 / Anemia / Antigens / Blood / Cancer Research / Care and treatment / Conditioning / Critical Care Medicine / Cytogenetics / Development and progression / Disease control / Donor Selection / Genetic aspects / Health risks / Hematology / Hematopoietic Stem Cell Transplantation / Hematopoietic stem cells / Histocompatibility antigen HLA / Histocompatibility Testing / HLA antigens / Humans / Immunosuppressive agents / Intensive / Internal Medicine / Leukocytes / Lymphocytes / Management / Medicine / Medicine & Public Health / Myelofibrosis / Oncology / Optimization / Peripheral blood / Primary Myelofibrosis - mortality / Primary Myelofibrosis - therapy / review / Risk / Splenectomy / Stem cell transplantation / Stem cells / Transfusion / Transplantation / Transplantation Conditioning / Transplantation, Homologous / Transplants / Transplants & implants