Clinical Outcomes of Allogeneic Stem Cell Transplantation in Myelofibrosis - A Single Center Experience

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Background: There is paucity of data on the outcomes of allogeneic stem cell transplantation (allo-SCT) for myelofibrosis, from developing countries.Materials and Methods: This is a retrospective analysis of patients undergoing allogeneic stem cell transplant for myelofibrosis at our center between January 1998 to December 2023.Results: Thirty-four patients underwent allogeneic transplantation with a median age of 46 (19-68) years with 24 (70.6%)being males.The median dynamic international prognostic scoring system (DIPSS) Score was 3 (2-4).JAK2 was the most common driver mutation, in 10 (34.5%) patients.Majority of patients received reduced intensity conditioning with Fludarabine-Melphalan +/-total body irradiation (n=32) and all had peripheral blood grafts with donor source being matched sibling in 22 (64.7%),unrelated donor in 9 (26.5%)[7 full HLA match, one 9/10 HLA match and one 8/10 HLA match] and haploidentical in 3 (8.8%).The median CD34 cell dose infused was 9.9 (3.4-22) × 10 6 /kg.The majority received calcineurin inhibitor + methotrexate (n=28) as Graft versus Host Disease (GVHD) prophylaxis.Two patients died before day 14 due to sepsis while 3 (9.3%)had primary graft failure.Neutrophil engraftment occurred in 29 patients (85.3%) at a median of 15 (range 8-25) days.Acute GVHD was noted in 20 (58.8%) patients with grade 3-4 GVHD in 13 (38.2%).Chronic GVHD was noted in 12 patients with 4 being extensive chronic GVHD as per revised Seattle criteria.On last follow up, 15 (44.1%) patients are alive while 19 have died.Conclusion: Allo-SCT for myelofibrosis is associated with reasonable cure rates, however strategies to reduce graft failure and GVHD are required.

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