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

2015; Springer Nature; Volume: 29; Issue: 11 Linguagem: Inglês

10.1038/leu.2015.233

1476-5551

Nicolaus Kröger, H. J. Deeg, Eduardo Olavarría, Dietger Niederwieser, Andrea Bacigalupo, Tiziano Barbui, Alessandro Rambaldi, Ruben A. Mesa, Ayalew Tefferi, Martin Grießhammer, Vikas Gupta, Claire Harrison, Haefaa Alchalby, Alessandro M. Vannucchi, Francisco Cervantes, Marie Robin, Markus Ditschkowski, Veena Fauble, Donal P. McLornan, Karen K. Ballen, Uday Popat, Francesco Passamonti, Damiano Rondelli, Giovanni Barosi,

Acute Myeloid Leukemia Research

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 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.