Canterbury DHB

Context

Allografting

It is important to carefully consider patients who may benefit from allogeneic transplantation.

The median overall survival for patients with PMF is 6 years, but this can vary widely between 1 to 30 years for individual patients. Only 17% of patients presenting with PMF are aged <50 years old.

A retrospective analysis of 483 patients aged <65 years suggested survival benefit post allograft only for patients with:

Traditionally, data detailing outcomes of allografts performed for PMF tend to have highly selected patients with low median age (40–50 years), and there are virtually no prospective RCT studies in this area. Overall survival in younger, "fitter” patients is around 40–60% at 3–4 years.

The European LeukemiaNet (ELN) and European Society for Blood and Marrow Transplantation (EBMT) have developed consensus recommendations for HCT in PMF which suggest:

Molecular status has an impact on survival in PMF, but a retrospective analysis by Kröger et al. (2015)4 suggests that molecular data can also help predict outcome post transplant.

Kröger et al. also found ASXL1 and IDH2 mutations to be independent risk factors for lower PFS (HR, 1.53 [P = .008], and HR 5.451 [P = .002], respectively). They identified CALR mutation to be an independent factor for lower NRM (HR, .415; P = .05), improved PFS (HR, .393; P = .01), and OS (HR, .448; P = .03).

When an appropriate hematopoietic stem cell transplantation (HSCT) candidate is identified, select the most appropriate donor and conditioning protocol for that individual in light of the most recent evidence.

The value of splenectomy pre allograft in patients with massive splenomegaly is controversial, and there is conflicting data. This decision should therefore also be individualised.

In patients progressing post allograft, there may be a role for donor lymphocyte infusion (DLI).

About this Canterbury DHB document (6245):

Document Owner:

Sean Macpherson (see Who's Who)

Issue Date:

August 2018

Next Review:

April 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer

Topic Code: 6245