Indication and management of allogeneic stem cell transplantation in primary myelofibrosis: a consensus process by an EBMT/ELN international working group
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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. / Kröger, N M; Deeg, J H; Olavarria, E; Niederwieser, D; Bacigalupo, A; Barbui, T; Rambaldi, A; Mesa, R; Tefferi, A; Griesshammer, M; Gupta, V; Harrison, C; Alchalby, H; Vannucchi, A M; Cervantes, F; Robin, M; Ditschkowski, M; Fauble, V; McLornan, D; Ballen, K; Popat, U R; Passamonti, F; Rondelli, D; Barosi, G.
In: LEUKEMIA, Vol. 29, No. 11, 11.2015, p. 2126-33.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Indication and management of allogeneic stem cell transplantation in primary myelofibrosis: 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
PY - 2015/11
Y1 - 2015/11
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.
KW - Donor Selection
KW - Hematopoietic Stem Cell Transplantation
KW - Histocompatibility Testing
KW - Humans
KW - Primary Myelofibrosis
KW - Transplantation Conditioning
KW - Transplantation, Homologous
U2 - 10.1038/leu.2015.233
DO - 10.1038/leu.2015.233
M3 - SCORING: Journal article
C2 - 26293647
VL - 29
SP - 2126
EP - 2133
JO - LEUKEMIA
JF - LEUKEMIA
SN - 0887-6924
IS - 11
ER -