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Thiotepa–busulfan–fludarabine (TBF) conditioning regimen in patients undergoing allogeneic hematopoietic cell transplantation for myelofibrosis: an outcome analysis from the Chronic Malignancies Working Party of the EBMT

Bone Marrow Transplantation volume 56, pages 1593–1602 (2021)Cite this article

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Abstract

Allogeneic hematopoietic cell transplantation (allo-HCT) remains the only curative option in MF. There is no consensus on the optimal conditioning regimen. We report outcomes of 187 patients with MF transplanted between 2010 and 2017 conditioned with TBF. Median age was 58 years. Median interval from diagnosis to allo-HCT was 44 months. Donors were haploidentical (41%), unrelated (36%) or HLA-identical siblings (23%). Stem cell source was PB in 60%. Conditioning was myeloablative in 48% of cases. Antithymocyte globulin (ATG) was used in 41% of patients. At 100 days, neutrophil and platelet engraftment were 91% and 63% after a median of 21 and 34 days, respectively. Grade II-IV and III-IV acute GVHD occurred in 24% and 12%, while at 3 years, all grade chronic GVHD and chronic extensive GVHD had been diagnosed in 38% and 11%. At 3 years, OS, RFS and GRFS were 55%, 49% and 43%, respectively. RI and NRM were 17% and 33%. On multivariate analysis, poor KPS and the use of unrelated donors were associated with worse GRFS and a higher grade II-IV acute GVHD, respectively. Neither donor type nor intensity of the conditioning regimen influenced survival outcomes. TBF is a feasible conditioning regimen in allo-HCT for MF in all donor settings although longer term outcomes are required.

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Author information

Authors and Affiliations

  1. Department of Clinical Medicine and Surgery, Federico II University of Naples, Naples, Italy

    Giorgia Battipaglia

  2. EBMT Statistical Unit, Leiden, Netherlands

    Katya Mauff

  3. EBMT Data Office, Leiden, Netherlands

    Lotus Wendel

  4. IRCCS Ospedale Policlinico San Martino, Genova, Italy

    Emanuele Angelucci

  5. Department of Clinical Hematology and Cellular Therapy, Saint-Antoine Hospital, AP-HP, Sorbonne University, Paris, France

    Mohamad Mohty

  6. Hematology, Stem Cell Transplant Unit, University Tor Vergata, Rome, Italy

    William Arcese

  7. Ospedale Civile Dipartimento di Ematologia, Medicina Trasfusionale e Biotecnologie, Pescara, Italy

    Stella Santarone

  8. Department of Hematology, Hôpital Brabois, CHRU Nancy and CNRS UMR 7365, Biopole del’Université del Lorraine, Vendoeuvre les Nancy, France

    Marie Therese Rubio

  9. Department of Stem Cell Transplantation, Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Nicolaus Kroger

  10. Department of Hematology, Vall d’Hebron Institute of Oncology (VHIO), University Hospital Vall d’Hebron, Barcelona, Spain

    Maria Laura Fox

  11. Department of Hematology, Institut Paoli Calmettes, Marseille, France

    Didier Blaise

  12. Hematology, Department of Translational and Precision Medicine, University Sapienza, Rome, Italy

    Anna Paola Iori

  13. Division of Hematology and Stem Cell Transplantation, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy

    Renato Fanin

  14. Division of Hematology, University of Geneva Hospitals, Geneva, Switzerland

    Yves Chalandon

  15. Hematology Division and Bone Marrow Transplantation Unit, San Gerardo Hospital, Monza, Italy

    Pietro Pioltelli

  16. Department of Oncology, UOSA Transplant and Cellular Therapy Center, Azienda Ospedaliera Universitaria Senese, Siena, Italy

    Giuseppe Marotta

  17. Fondazione Policlinico A. Gemelli IRCCS, Roma, Italy

    Patrizia Chiusolo

  18. Istituto di Ematologia, Università Cattolica del Sacro Cuore, Roma, Italy

    Patrizia Chiusolo

  19. Department of Hematology, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Matjaz Sever

  20. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

    Matjaz Sever

  21. Hematology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain

    Carlos Solano & Juan Carlos Hernandez-Boluda

  22. Centre Henri Becquerel, Rouen, France

    Nathalie Contentin

  23. Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands

    Liesbeth C. de Wreede

  24. Department of Bone Marrow Transplantation and Onco-Hematology, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland

    Tomasz Czerw

  25. Department of Haematology, Trinity College Dublin, St. James’s Hospital, Dublin, Ireland

    Patrick Hayden

  26. Department of Haematology, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK

    Donal McLornan

  27. CHU de Lille, univ Lille, INSERM U1286, Infinite, 59000, Lille, France

    Ibrahim Yakoub-Agha

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  1. Giorgia Battipaglia
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Contributions

GB designed the study and wrote the manuscript. LW, KM and LCDW checked data and performed the statistical analysis. GB, MK, DM,TC, PH and IYA revised the manuscript and all the authors revised its final version. all authors revised the final version. EA, MM, WA, SS, MTR, NK, MLF, DB, API, RF, YC, PP, GM, PC, MS, CS, NC, LCDW, TC, JCHB were the principal investigators at the centres recruiting the highest number of patients for the study.

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Correspondence to Giorgia Battipaglia or Donal McLornan.

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Battipaglia, G., Mauff, K., Wendel, L. et al. Thiotepa–busulfan–fludarabine (TBF) conditioning regimen in patients undergoing allogeneic hematopoietic cell transplantation for myelofibrosis: an outcome analysis from the Chronic Malignancies Working Party of the EBMT. Bone Marrow Transplant 56, 1593–1602 (2021). https://doi.org/10.1038/s41409-021-01222-z

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