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:	Bridgett McDiarmid (see Who's Who)
Last Reviewed:	August 2018
Next Review:	April 2021
Keywords:
Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document. Disclaimer The Haematology Department Protocols and Guidelines (the Red Book) are intended as a guide for registered health professionals to communicate guidelines and share best practices with supporting health professionals within New Zealand district health boards. They are not intended to be provided to or used as a reference for patients or non-registered health professionals. All health professionals must exercise their own clinical judgement and use pertinent clinical data when treating patients. The authors and editors of this publication have checked with sources believed to be reliable in their effort to provide information that is complete and in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical science, neither the authors, editors, publisher, nor any other party who has been involved in preparing or publishing this work warrants that the information contained in it is accurate or complete in every respect. They therefore have no liability (whether in tort (including negligence) or otherwise) for any loss or damage arising out of any reliance on this information. This publication has been compiled by the staff and contractors of Canterbury District Health Board (CDHB) and as such CDHB has copyright for this book. Amendments must be authorised in accordance with the documented process. No release of part of, or all of, this publication to any other party or organisation is permissible without the prior approval of the designated document owner.
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