Allogeneic Hematopoietic Stem Cell Transplantation for Post-essential Thrombocythemia and Post-polycythemia Vera Myelofibrosis

Makoto Murata; Ritsuro Suzuki; Tetsuya Nishida; Shuichi Shirane; Yutaka Shimazu; Yosuke Minami; Takehiko Mori; Noriko Doki; Yoshinobu Kanda; Naoyuki Uchida; Masatsugu Tanaka; Jun Ishikawa; Kazuto Togitani; Takahiro Fukuda; Tatsuo Ichinohe; Yoshiko Atsuta; Tokiko Nagamura-Inoue; Hitoshi Kiyoi

doi:10.2169/internalmedicine.4375-19

ORIGINAL ARTICLES

Allogeneic Hematopoietic Stem Cell Transplantation for Post-essential Thrombocythemia and Post-polycythemia Vera Myelofibrosis

Makoto Murata, Ritsuro Suzuki, Tetsuya Nishida, Shuichi Shirane, Yutaka Shimazu, Yosuke Minami, Takehiko Mori, Noriko Doki, Yoshinobu Kanda, Naoyuki Uchida, Masatsugu Tanaka, Jun Ishikawa, Kazuto Togitani, Takahiro Fukuda, Tatsuo Ichinohe, Yoshiko Atsuta, Tokiko Nagamura-Inoue, Hitoshi Kiyoi

Author information

Makoto Murata
Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Japan
Adult CML/MPN Working Group of the Japan Society for Hematopoietic Cell Transplantation, Japan
Ritsuro Suzuki
Department of Oncology and Hematology, Shimane University Hospital, Japan
Tetsuya Nishida
Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Japan
Shuichi Shirane
Adult CML/MPN Working Group of the Japan Society for Hematopoietic Cell Transplantation, Japan
Division of Hematology, Department of Internal Medicine, Juntendo University, Japan
Yutaka Shimazu
Adult CML/MPN Working Group of the Japan Society for Hematopoietic Cell Transplantation, Japan
Department of Hematology, Japanese Red Cross Wakayama Medical Center, Japan
Yosuke Minami
Adult CML/MPN Working Group of the Japan Society for Hematopoietic Cell Transplantation, Japan
Department of Hematology, National Cancer Center Hospital East, Japan
Takehiko Mori
Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
Noriko Doki
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Japan
Yoshinobu Kanda
Division of Hematology, Jichi Medical University, Japan
Naoyuki Uchida
Department of Hematology, Toranomon Hospital, Japan
Masatsugu Tanaka
Department of Hematology, Kanagawa Cancer Center, Japan
Jun Ishikawa
Department of Hematology, Osaka International Cancer Institute, Japan
Kazuto Togitani
Department of Hematology, Kochi Medical School, Japan
Takahiro Fukuda
Hematopoietic Stem Cell Transplantation Division, National Cancer Center Hospital, Japan
Tatsuo Ichinohe
Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan
Yoshiko Atsuta
Japanese Data Center for Hematopoietic Cell Transplantation, Japan
Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Japan
Tokiko Nagamura-Inoue
Adult CML/MPN Working Group of the Japan Society for Hematopoietic Cell Transplantation, Japan
Department of Cell Processing and Transfusion, Japan
Hitoshi Kiyoi
Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Japan

Keywords: myelofibrosis, essential thrombocythemia, polycythemia vera, hematopoietic stem cell transplantation, cord blood

JOURNAL OPEN ACCESS

2020 Volume 59 Issue 16 Pages 1947-1956

DOI https://doi.org/10.2169/internalmedicine.4375-19

Details

Abstract

Objective Little information is available about the outcome of allogeneic hematopoietic stem cell transplantation (HSCT) for patients with secondary myelofibrosis from essential thrombocythemia (ET) and polycythemia vera (PV). A nationwide retrospective study of the outcome of HSCT for post-ET and post-PV myelofibrosis was conducted in Japan.

Patients and Methods Clinical data for patients with post-ET (n=29) and post-PV (n=9) myelofibrosis who had received first allogeneic HSCT were extracted from the Transplant Registry Unified Management Program, which is a registry of the outcomes of HSCT in Japan.

Results Five patients died without neutrophil recovery within 60 days after transplantation. The incidence of neutrophil recovery was significantly lower in umbilical cord blood (UCB) transplantation than in related donor transplantation (40% vs. 92%, p=0.010). The 1-year non-relapse mortality for post-ET and post-PV myelofibrosis was 35% and 27%, respectively (p=0.972). No patient or transplantation characteristics were associated with non-relapse mortality. The 4-year overall survival for post-ET and post-PV myelofibrosis was 46% and 65%, respectively (p=0.362). A univariate analysis identified UCB transplantation (vs. related donor, p=0.017) and ≥10 times red blood cell transfusions before transplantation (vs. <10 times, p=0.037) as predictive of a lower overall survival.

Conclusion Allogeneic HSCT provides a long-term survival for at least some patients with post-ET and post-PV myelofibrosis. Further studies with more patients are required to determine the best alternative donor.

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