Association between the choice of the conditioning regimen and outcomes of allogeneic hematopoietic cell transplantation for myelofibrosis

被引：19

作者：

Murthy, Guru Subramanian Guru ^{[1
]}

Kim, Soyoung ^{[2
,3
]}

Estrada-Merly, Noel ^{[3
]}

Abid, Muhammad Bilal

Aljurf, Mahmoud ^{[4
]}

Assal, Amer ^{[5
]}

Badar, Talha ^{[6
]}

Badawy, Sherif M. ^{[7
,8
]}

Ballen, Karen ^{[9
]}

Beitinjaneh, Amer ^{[10
]}

Cerny, Jan ^{[11
]}

Chhabra, Saurabh ^{[3
]}

DeFilipp, Zachariah ^{[12
]}

Dholaria, Bhagirathbhai ^{[13
]}

Perez, MiguelAngel Diaz ^{[14
]}

Farhan, Shatha ^{[15
]}

Freytes, Cesar O. ^{[16
]}

Gale, Robert Peter ^{[17
]}

Ganguly, Siddhartha ^{[18
]}

Gupta, Vikas ^{[19
]}

Grunwald, Michael R. ^{[20
]}

Hamad, Nada ^{[21
]}

Hildebrandt, Gerhard C. ^{[22
]}

Inamoto, Yoshihiro ^{[23
]}

Jain, Tania ^{[24
]}

Jamy, Omer ^{[25
]}

Juckett, Mark ^{[26
]}

Kalaycio, Matt ^{[27
]}

Krem, Maxwell M. ^{[28
]}

Lazarus, Hillard M. ^{[29
]}

Litzow, Mark ^{[30
]}

Munker, Reinhold ^{[22
]}

Murthy, Hemant S. ^{[31
,32
]}

Nathan, Sunita ^{[33
]}

Nishihori, Taiga ^{[34
]}

Orti, Guillermo ^{[35
]}

Patel, Sagar S. ^{[36
]}

van der Poel, Marjolein ^{[37
]}

Rizzieri, David A. ^{[38
]}

Savani, Bipin N. ^{[39
]}

Seo, Sachiko ^{[40
]}

Solh, Melhem ^{[41
]}

Verdonck, Leo F. ^{[42
]}

Wirk, Baldeep ^{[43
]}

Yared, Jean A. ^{[44
]}

Nakamura, Ryotaro ^{[45
]}

Oran, Betul ^{[46
]}

Scott, Bart ^{[47
]}

Saber, Wael ^{[3
]}

机构：

[1] Med Coll Wisconsin, Div Hematol & Oncol, Milwaukee, WI 53226 USA

[2] Med Coll Wisconsin, Inst Hlth & Equ, Div Biostat, Milwaukee, WI USA

[3] Med Coll Wisconsin, CIBMTR Ctr Int Blood & Marrow Transplant Res, Dept Med, Milwaukee, WI USA

[4] King Faisal Specialist Hosp Ctr & Res, Dept Oncol, Riyadh, Saudi Arabia

[5] Columbia Univ, Dept Med Bone Marrow Transplant & Cell Therapy Pro, Irving Med Ctr, New York, NY USA

[6] Mayo Clin, Jacksonville, FL USA

[7] Ann & Robert H Lurie Childrens Hosp Chicago, Div Hematol Oncol & Stem Cell Transplantat, Chicago, IL USA

[8] Northwestern Univ, Dept Pediat, Feinberg Sch Med, Chicago, IL USA

[9] Univ Virginia Hlth Syst, Div Hematol Oncol, Charlottesville, VA USA

[10] Univ Miami Hosp &Clin, Slyvester Comprehens Canc Ctr, Div Transplantat & Cellular Therapy, Miami, FL USA

[11] Univ Massachusetts, Dept Med, Div Hematol Oncol, Med Ctr, Worcester, MA USA

[12] Massachusetts Gen Hosp, Hematopoiet Cell Transplant & Cellular Therapy Pro, Boston, MA USA

[13] Vanderbilt Univ, Med Ctr, Nashville, TN USA

[14] Univ Nino Jesus, Hosp Infantil, Dept Hematol Oncol, Madrid, Spain

[15] Henry Ford Hlth Syst, Stem Cell Transplant & Cellular Therapy Program, Detroit, MI USA

[16] Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX USA

[17] Imperial Coll London, Hematol Res Ctr, Dept Immunol & Inflammat, London, England

[18] Univ Kansas Hlth Syst, Div Hematol Malignancy & Cellular Therapeut, Kansas City, KS USA

[19] Univ Toronto, Princess Margaret Canc Ctr, MPN Program, Toronto, ON, Canada

[20] Atrium Hlth, Levine Canc Inst, Dept Hematol Oncol & Blood Disorders, Charlotte, NC USA

[21] St Vincent Hosp, Darlinghurst, NSW, Australia

[22] Univ Kentucky, Markey Canc Ctr, Lexington, KY USA

[23] Natl Canc Ctr, Div Hematopoiet Stem Cell Transplantat, Tokyo, Japan

[24] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[25] Univ Alabama Birmingham, Birmingham, AL USA

[26] Univ Minnesota, Blood & Marrow Transplant Program Adults, Minneapolis, MN USA

[27] Cleveland Clin, Taussig Canc Inst, Cleveland, OH USA

[28] Kansas City VA Med Ctr, Kansas City, MO USA

[29] Case Western Reserve Univ, Univ Hosp Cleveland Med Ctr, Cleveland, OH USA

[30] Mayo Clin Rochester, Div Hematol, Rochester, MN USA

[31] Mayo Clin, Blood & Marrow Transplantat Program, Div Hematol Oncol, Jacksonville, FL USA

[32] Mayo Clin Rochester, Transplant Ctr, Rochester, MN USA

[33] Rush Univ, Sect Bone Marrow Transplant & Cell Therapy, Med Ctr, Chicago, IL USA

[34] H Lee Moffitt Canc Ctr & Res Inst, Dept Blood & Marrow Transplant & Cellular Immunoth, Tampa, FL USA

[35] Vall dHebron Univ Hosp, Barcelona, Spain

[36] Univ Utah, Huntsman Canc Inst, Blood & Marrow Transplant Program, Salt Lake City, UT USA

[37] Masstricht Univ, GROW Sch Oncol & Dev Biol, Dept Internal Med, Div Hematol,Med Ctr, Maastricht, Netherlands

[38] Duke Univ, Div Hematol Malignancies & Cellular Therapy, Durham, NC USA

[39] Vanderbilt Univ, Dept Med, Div Hematol Oncol, Med Ctr, Nashville, TN USA

[40] Dokkyo Med Univ, Dept Hematol & Oncol, Mibu, Tochigo, Japan

[41] Northside Hosp, Blood & Marrow Transplant Grp Georgia, Atlanta, GA USA

[42] Isala Clin, Dept Hematol Oncol, Zwolle, Netherlands

[43] Penn State Canc Inst, Bone Marrow Transplant Program, Hershey, PA USA

[44] Univ Maryland, Greenebaum Comprehens Canc Ctr, Dept Med, Div Hematol Oncol,Transplantat & Cellular Therapy, Baltimore, MD USA

[45] City Hope Natl Med Ctr, Dept Hematol & Hematopoiet Cell Transplantat, Duarte, CA USA

[46] Univ Texas MD Anderson Canc Ctr Houston, Dept Stem Cell Transplantat, Div Canc Med, Houston, TX USA

[47] Fred Hutchinson Canc Res Ctr, Seattle, WA USA

来源：

HAEMATOLOGICA | 2023年 / 108卷 / 07期

关键词：

INTERNATIONAL-BLOOD;

D O I：

10.3324/haematol.2022.281958

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative treatment for myelofibrosis. However, the optimal conditioning regimen either with reduced-intensity conditioning (RIC) or myeloablative conditioning (MAC) is not well known. Using the Center for International Blood and Marrow Transplant Research database, we identified adults aged & GE;18 years with myelofibrosis undergoing allo-HCT between 2008-2019 and analyzed the outcomes separately in the RIC and MAC cohorts based on the conditioning regimens used. Among 872 eligible patients, 493 underwent allo-HCT using RIC (fludara-bine/busulfan n=166, fludarabine/melphalan n=327) and 379 using MAC (fludarabine/busulfan n=247, busulfan/cyclophospha-mide n=132). In multivariable analysis with RIC, fludarabine/melphalan was associated with inferior overall survival (hazard ratio [HR]=1.80; 95% confidenec interval [CI]: 1.15-2.81; P=0.009), higher early non-relapse mortality (HR=1.81; 95% CI: 1.12-2.91; P=0.01) and higher acute graft -versus-host disease (GvHD) (grade 2-4 HR=1.45; 95% CI: 1.03-2.03; P=0.03; grade 3-4 HR=2.21; 95%CI: 1.28-3.83; P=0.004) compared to fludarabine/busulfan. In the MAC setting, busulfan/cyclophosphamide was associated with a higher acute GvHD (grade 2-4 HR=2.33; 95% CI: 1.67-3.25; P<0.001; grade 3-4 HR=2.31; 95% CI: 1.52-3.52; P<0.001) and inferior GvHD-free relapse-free survival (GRFS) (HR=1.94; 95% CI: 1.49-2.53; P<0.001) as compared to fludarabine/busulfan. Hence, our study suggests that fludarabine/busulfan is associated with better outcomes in RIC (better overall survival, lower early non-relapse mortality, lower acute GvHD) and MAC (lower acute GvHD and better GRFS) in myelofibrosis.

引用

页码：1900 / 1908

页数：9

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