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Conditioning

Effect of conditioning regimens on graft failure in myelofibrosis: a retrospective analysis

Bone Marrow Transplantation volume 50, pages 1424–1431 (2015)Cite this article

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Abstract

In myelofibrosis, the introduction of reduced-intensity conditioning (RIC) preceding allogeneic stem cell transplantation (SCT) resulted in lower transplant-related mortality rates compared with myeloablative conditioning. However, lowering the intensity of conditioning may increase the risk of graft failure in myelofibrosis, although hitherto this has not been indisputably proven. We here report the outcome of 53 patients who underwent allogeneic SCT with different conditioning regimens (RIC and non-myeloablative (NMA)) in three transplantation centers in the Netherlands. The cumulative incidence of graft failure within 60 days after SCT was high (28%), and this was primarily associated with the intensity of the conditioning regimen. Cumulative neutrophil engraftment at 60 days was lower in patients who received NMA conditioning compared with those who received RIC (56% vs 84%, P=0.03). Furthermore, of six patients who received a second transplantation after graft failure, the three patients with RIC regimens subsequently engrafted, whereas the three patients who received a second NMA regimen did not. This study indicates that in myelofibrosis, NMA regimens result in high engraftment failure rates. We propose the use of more intensive conditioning regimens, incorporating busulfan or melphalan.

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Acknowledgements

We kindly thank the following persons for their work concerning the mutational analyses: L van de Corput (Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht, the Netherlands), PJM Valk (Laboratory of Molecular diagnostics, Erasmus Medical Center, Rotterdam, the Netherlands), KGM Smolders and PA Merle (Department of Haematology, VU University Medical Center, Amsterdam, the Netherlands).

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Authors and Affiliations

  1. Department of Haematology, VU University Medical Center, Amsterdam, the Netherlands

    S Slot, K Smits, N W C J van de Donk, J J W M Janssen & S Zweegman

  2. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands

    B I Witte

  3. Department of Haematology, University Medical Center Utrecht, Utrecht, the Netherlands

    R Raymakers & A E C Broers

  4. Department of Haematology, Erasmus Medical Center, Rotterdam, the Netherlands

    P A W te Boekhorst

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  1. S Slot
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Correspondence to S Slot.

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Slot, S., Smits, K., van de Donk, N. et al. Effect of conditioning regimens on graft failure in myelofibrosis: a retrospective analysis. Bone Marrow Transplant 50, 1424–1431 (2015). https://doi.org/10.1038/bmt.2015.172

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