Allogeneic stem cell transplantation for myelodysplastic syndromes with bone marrow fibrosis

Nicolaus Kröger, Tatjana Zabelina, Anja van Biezen, Ronald Brand, Dietger Niederwieser, Rodrigo Martino, Zi Yi Lim, Francesco Onida, Christoph Schmid, Laurent Garderet, Marie Robin, Michael van Gelder, Reinhard Marks, Argiris Symeonidis, Guido Kobbe, Theo de Witte

Research output: Contribution to journalArticle

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Abstract

Background Bone marrow fibrosis in patients with myelodysplastic syndrome is associated with a poor outcome, but whether the outcome after allogeneic stem cell transplantation is related to the degree of bone marrow fibrosis is unknown. Design and Methods Patients with myelodysplastic syndrome and known bone marrow histology (n=721) who underwent hematopoietic stem cell transplantation were classified according to the degree of bone marrow fibrosis into those without fibrosis (n=483), those with mild or moderate fibrosis (n=199) and those with severe fibrosis (n=39) and analyzed regarding engraftment, treatmentrelated mortality, relapse and survival. Results The degree of fibrosis was not associated with disease status or abnormal cytogenetics. The cumulative incidence of engraftment achieved at day +30 in non-fibrotic patients was 93% and was significantly lower in those with mild or moderate fibrosis (89%) and severe fibrosis (75%) (P=0.009). Neutrophil engraftment occurred later in patients with mild or moderate fibrosis and severe fibrosis than in patients without fibrosis (median 17 versus 20 versus 16 days, respectively; P=0.002). The cumulative incidence of relapse at 3 years was significantly higher in patients with severe fibrosis than in those with a lesser degree of fibrosis or no fibrosis (47% versus 28% versus 27%, respectively; P=0.04), resulting in comparable 3-year disease-free survival rates in patients without fibrosis and in those with mild or moderate fibrosis (42% versus 38%, respectively) but a lower disease-free survival rate in those with severe fibrosis (18%; P=0.002). Severe fibrosis remained an independent factor for reduced survival (hazard ratio, 1.9; P=0.006). Conclusions Among patients with myelodysplastic syndromes, only severe fibrosis affects survival after hematopoietic stem cell transplantation while patients with mild or moderate fibrosis have an outcome comparable to that of patients without bone marrow fibrosis & copy 2011 Ferrata Storti Foundation. This is an open-access paper.

Original languageEnglish
Pages (from-to)291-297
Number of pages7
JournalHaematologica
Volume96
Issue number2
DOIs
Publication statusPublished - Feb 2011

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Primary Myelofibrosis
Myelodysplastic Syndromes
Stem Cell Transplantation
Fibrosis
Hematopoietic Stem Cell Transplantation
Disease-Free Survival
Survival
Survival Rate
Recurrence
Incidence

Keywords

  • Allogeneic stem cell transplantation
  • Bone marrow fibrosis
  • Engraftment
  • Myelodysplastic syndromes

ASJC Scopus subject areas

  • Hematology

Cite this

Kröger, N., Zabelina, T., van Biezen, A., Brand, R., Niederwieser, D., Martino, R., ... de Witte, T. (2011). Allogeneic stem cell transplantation for myelodysplastic syndromes with bone marrow fibrosis. Haematologica, 96(2), 291-297. https://doi.org/10.3324/haematol.2010.031229

Allogeneic stem cell transplantation for myelodysplastic syndromes with bone marrow fibrosis. / Kröger, Nicolaus; Zabelina, Tatjana; van Biezen, Anja; Brand, Ronald; Niederwieser, Dietger; Martino, Rodrigo; Lim, Zi Yi; Onida, Francesco; Schmid, Christoph; Garderet, Laurent; Robin, Marie; van Gelder, Michael; Marks, Reinhard; Symeonidis, Argiris; Kobbe, Guido; de Witte, Theo.

In: Haematologica, Vol. 96, No. 2, 02.2011, p. 291-297.

Research output: Contribution to journalArticle

Kröger, N, Zabelina, T, van Biezen, A, Brand, R, Niederwieser, D, Martino, R, Lim, ZY, Onida, F, Schmid, C, Garderet, L, Robin, M, van Gelder, M, Marks, R, Symeonidis, A, Kobbe, G & de Witte, T 2011, 'Allogeneic stem cell transplantation for myelodysplastic syndromes with bone marrow fibrosis', Haematologica, vol. 96, no. 2, pp. 291-297. https://doi.org/10.3324/haematol.2010.031229
Kröger N, Zabelina T, van Biezen A, Brand R, Niederwieser D, Martino R et al. Allogeneic stem cell transplantation for myelodysplastic syndromes with bone marrow fibrosis. Haematologica. 2011 Feb;96(2):291-297. https://doi.org/10.3324/haematol.2010.031229
Kröger, Nicolaus ; Zabelina, Tatjana ; van Biezen, Anja ; Brand, Ronald ; Niederwieser, Dietger ; Martino, Rodrigo ; Lim, Zi Yi ; Onida, Francesco ; Schmid, Christoph ; Garderet, Laurent ; Robin, Marie ; van Gelder, Michael ; Marks, Reinhard ; Symeonidis, Argiris ; Kobbe, Guido ; de Witte, Theo. / Allogeneic stem cell transplantation for myelodysplastic syndromes with bone marrow fibrosis. In: Haematologica. 2011 ; Vol. 96, No. 2. pp. 291-297.
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abstract = "Background Bone marrow fibrosis in patients with myelodysplastic syndrome is associated with a poor outcome, but whether the outcome after allogeneic stem cell transplantation is related to the degree of bone marrow fibrosis is unknown. Design and Methods Patients with myelodysplastic syndrome and known bone marrow histology (n=721) who underwent hematopoietic stem cell transplantation were classified according to the degree of bone marrow fibrosis into those without fibrosis (n=483), those with mild or moderate fibrosis (n=199) and those with severe fibrosis (n=39) and analyzed regarding engraftment, treatmentrelated mortality, relapse and survival. Results The degree of fibrosis was not associated with disease status or abnormal cytogenetics. The cumulative incidence of engraftment achieved at day +30 in non-fibrotic patients was 93{\%} and was significantly lower in those with mild or moderate fibrosis (89{\%}) and severe fibrosis (75{\%}) (P=0.009). Neutrophil engraftment occurred later in patients with mild or moderate fibrosis and severe fibrosis than in patients without fibrosis (median 17 versus 20 versus 16 days, respectively; P=0.002). The cumulative incidence of relapse at 3 years was significantly higher in patients with severe fibrosis than in those with a lesser degree of fibrosis or no fibrosis (47{\%} versus 28{\%} versus 27{\%}, respectively; P=0.04), resulting in comparable 3-year disease-free survival rates in patients without fibrosis and in those with mild or moderate fibrosis (42{\%} versus 38{\%}, respectively) but a lower disease-free survival rate in those with severe fibrosis (18{\%}; P=0.002). Severe fibrosis remained an independent factor for reduced survival (hazard ratio, 1.9; P=0.006). Conclusions Among patients with myelodysplastic syndromes, only severe fibrosis affects survival after hematopoietic stem cell transplantation while patients with mild or moderate fibrosis have an outcome comparable to that of patients without bone marrow fibrosis & copy 2011 Ferrata Storti Foundation. This is an open-access paper.",
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AU - Kröger, Nicolaus

AU - Zabelina, Tatjana

AU - van Biezen, Anja

AU - Brand, Ronald

AU - Niederwieser, Dietger

AU - Martino, Rodrigo

AU - Lim, Zi Yi

AU - Onida, Francesco

AU - Schmid, Christoph

AU - Garderet, Laurent

AU - Robin, Marie

AU - van Gelder, Michael

AU - Marks, Reinhard

AU - Symeonidis, Argiris

AU - Kobbe, Guido

AU - de Witte, Theo

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N2 - Background Bone marrow fibrosis in patients with myelodysplastic syndrome is associated with a poor outcome, but whether the outcome after allogeneic stem cell transplantation is related to the degree of bone marrow fibrosis is unknown. Design and Methods Patients with myelodysplastic syndrome and known bone marrow histology (n=721) who underwent hematopoietic stem cell transplantation were classified according to the degree of bone marrow fibrosis into those without fibrosis (n=483), those with mild or moderate fibrosis (n=199) and those with severe fibrosis (n=39) and analyzed regarding engraftment, treatmentrelated mortality, relapse and survival. Results The degree of fibrosis was not associated with disease status or abnormal cytogenetics. The cumulative incidence of engraftment achieved at day +30 in non-fibrotic patients was 93% and was significantly lower in those with mild or moderate fibrosis (89%) and severe fibrosis (75%) (P=0.009). Neutrophil engraftment occurred later in patients with mild or moderate fibrosis and severe fibrosis than in patients without fibrosis (median 17 versus 20 versus 16 days, respectively; P=0.002). The cumulative incidence of relapse at 3 years was significantly higher in patients with severe fibrosis than in those with a lesser degree of fibrosis or no fibrosis (47% versus 28% versus 27%, respectively; P=0.04), resulting in comparable 3-year disease-free survival rates in patients without fibrosis and in those with mild or moderate fibrosis (42% versus 38%, respectively) but a lower disease-free survival rate in those with severe fibrosis (18%; P=0.002). Severe fibrosis remained an independent factor for reduced survival (hazard ratio, 1.9; P=0.006). Conclusions Among patients with myelodysplastic syndromes, only severe fibrosis affects survival after hematopoietic stem cell transplantation while patients with mild or moderate fibrosis have an outcome comparable to that of patients without bone marrow fibrosis & copy 2011 Ferrata Storti Foundation. This is an open-access paper.

AB - Background Bone marrow fibrosis in patients with myelodysplastic syndrome is associated with a poor outcome, but whether the outcome after allogeneic stem cell transplantation is related to the degree of bone marrow fibrosis is unknown. Design and Methods Patients with myelodysplastic syndrome and known bone marrow histology (n=721) who underwent hematopoietic stem cell transplantation were classified according to the degree of bone marrow fibrosis into those without fibrosis (n=483), those with mild or moderate fibrosis (n=199) and those with severe fibrosis (n=39) and analyzed regarding engraftment, treatmentrelated mortality, relapse and survival. Results The degree of fibrosis was not associated with disease status or abnormal cytogenetics. The cumulative incidence of engraftment achieved at day +30 in non-fibrotic patients was 93% and was significantly lower in those with mild or moderate fibrosis (89%) and severe fibrosis (75%) (P=0.009). Neutrophil engraftment occurred later in patients with mild or moderate fibrosis and severe fibrosis than in patients without fibrosis (median 17 versus 20 versus 16 days, respectively; P=0.002). The cumulative incidence of relapse at 3 years was significantly higher in patients with severe fibrosis than in those with a lesser degree of fibrosis or no fibrosis (47% versus 28% versus 27%, respectively; P=0.04), resulting in comparable 3-year disease-free survival rates in patients without fibrosis and in those with mild or moderate fibrosis (42% versus 38%, respectively) but a lower disease-free survival rate in those with severe fibrosis (18%; P=0.002). Severe fibrosis remained an independent factor for reduced survival (hazard ratio, 1.9; P=0.006). Conclusions Among patients with myelodysplastic syndromes, only severe fibrosis affects survival after hematopoietic stem cell transplantation while patients with mild or moderate fibrosis have an outcome comparable to that of patients without bone marrow fibrosis & copy 2011 Ferrata Storti Foundation. This is an open-access paper.

KW - Allogeneic stem cell transplantation

KW - Bone marrow fibrosis

KW - Engraftment

KW - Myelodysplastic syndromes

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