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

There is paucity of data on the outcomes of allogeneic stem cell transplantation (allo-SCT) for myelofibrosis, from developing countries.

This is a retrospective analysis of patients undergoing allogeneic stem cell transplant for myelofibrosis at our center between January 1998 to December 2023.

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) × 10⁶/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.

Allo-SCT for myelofibrosis is associated with reasonable cure rates, however strategies to reduce graft failure and GVHD are required.