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

被引:219
作者
Kroeger, N. M. [1 ]
Deeg, J. H. [2 ]
Olavarria, E. [3 ]
Niederwieser, D. [4 ]
Bacigalupo, A. [5 ]
Barbui, T. [6 ]
Rambaldi, A. [7 ]
Mesa, R. [8 ]
Tefferi, A. [9 ]
Griesshammer, M. [10 ]
Gupta, V. [11 ]
Harrison, C. [12 ]
Alchalby, H. [1 ]
Vannucchi, A. M. [13 ]
Cervantes, F. [14 ]
Robin, M. [15 ]
Ditschkowski, M. [16 ]
Fauble, V. [17 ]
McLornan, D. [12 ,18 ]
Ballen, K. [19 ]
Popat, U. R. [20 ]
Passamonti, F. [21 ,22 ]
Rondelli, D. [23 ,24 ]
Barosi, G. [25 ]
机构
[1] Univ Hamburg Hosp, Dept Stem Cell Transplantat, Hamburg, Germany
[2] Univ Washington, Fred Hutchinson Canc Res Ctr, Sch Med, Clin Res Div, Seattle, WA 98195 USA
[3] Hosp Navarra, Dept Hematol, Navarra Hlth Serv, Pamplona, Spain
[4] Univ Leipzig, Dept Haematol Clin Oncol & Hemostasiol, D-04109 Leipzig, Germany
[5] Osped San Martino Genova, Genoa, Italy
[6] Osped Papa Giovanni XXIII, Res Fdn, Bergamo, Italy
[7] Osped Papa Giovanni XXIII, Hematol & Bone Marrow Transplant Unit, Bergamo, Italy
[8] Mayo Clin, Div Hematol & Oncol, Scottsdale, AZ USA
[9] Mayo Clin, Dept Med, Div Hematol, Rochester, MN USA
[10] Johannes Wesling Teaching Hosp, Acad Dept Hematol & Oncol, Minden, Germany
[11] Univ Toronto, Princess Margaret Canc Ctr, Toronto, ON, Canada
[12] Guys & St Thomas NHS Fdn Trust, Dept Haematol, London, England
[13] Univ Florence, Dept Expt & Clin Med, Florence, Italy
[14] Univ Barcelona, IDIBAPS, Hosp Clin, Barcelona, Spain
[15] St Louis Hosp, Dept Hematol & Bone Marrow Transplantat, Paris, France
[16] Univ Hosp Essen, Ctr Comprehens Canc, WTZ, Dept Bone Marrow Transplantat, Essen, Germany
[17] Mayo Clin, Ctr Canc, Scottsdale, AZ USA
[18] Kings Coll Hosp London, Dept Haematol Med, London, England
[19] Massachusetts Gen Hosp, Div Hematol Oncol, Boston, MA 02114 USA
[20] Univ Texas MD Anderson Canc Ctr, Dept Stem Cell Transplantat & Cellular Therapy, Houston, TX 77030 USA
[21] Osped Circolo Varese, Univ Hosp, Dept Med, Div Hematol, Varese, Italy
[22] Fdn Macchi, Varese, Italy
[23] Univ Illinois, Hosp & Hlth Sci Syst, Chicago, IL USA
[24] Univ Illinois, Ctr Canc, Chicago, IL USA
[25] IRCCS Policlin S Matteo Fdn, Ctr Study Myelofibrosis, Pavia, Italy
关键词
PROGNOSTIC SCORING SYSTEM; PRETRANSPLANTATION SERUM FERRITIN; AGNOGENIC MYELOID METAPLASIA; BONE-MARROW-TRANSPLANTATION; REDUCED-INTENSITY; EUROPEAN GROUP; IRON OVERLOAD; MYELOPROLIFERATIVE NEOPLASMS; IDIOPATHIC MYELOFIBROSIS; LEUKEMIC TRANSFORMATION;
D O I
10.1038/leu.2015.233
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
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) 42%, 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.
引用
收藏
页码:2126 / 2133
页数:8
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