TY - JOUR
T1 - Indication and management of allogeneic stem cell transplantation in primary myelofibrosis
T2 - A consensus process by an EBMT/ELN international working group
AU - Kröger, N. M.
AU - Deeg, J. H.
AU - Olavarria, E.
AU - Niederwieser, D.
AU - Bacigalupo, A.
AU - Barbui, T.
AU - Rambaldi, A.
AU - Mesa, R.
AU - Tefferi, A.
AU - Griesshammer, M.
AU - Gupta, V.
AU - Harrison, C.
AU - Alchalby, H.
AU - Vannucchi, A. M.
AU - Cervantes, F.
AU - Robin, M.
AU - Ditschkowski, M.
AU - Fauble, V.
AU - McLornan, D.
AU - Ballen, K.
AU - Popat, U. R.
AU - Passamonti, F.
AU - Rondelli, D.
AU - Barosi, G.
N1 - Publisher Copyright:
© 2015 Macmillan Publishers Limited.
PY - 2015/11/1
Y1 - 2015/11/1
N2 - 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.
AB - 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.
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U2 - 10.1038/leu.2015.233
DO - 10.1038/leu.2015.233
M3 - Review article
C2 - 26293647
AN - SCOPUS:84946496578
SN - 0887-6924
VL - 29
SP - 2126
EP - 2133
JO - Leukemia
JF - Leukemia
IS - 11
ER -