PMID- 32994911 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220417 IS - 2040-6207 (Print) IS - 2040-6215 (Electronic) IS - 2040-6207 (Linking) VI - 11 DP - 2020 TI - HLA-mismatched donor and high ferritin level showed poor clinical outcomes after allogeneic hematopoietic cell transplantation in patients with advanced myelofibrosis. PG - 2040620720936935 LID - 10.1177/2040620720936935 [doi] LID - 2040620720936935 AB - BACKGROUND: Preconditioning intensity, donor choice and graft-versus-host disease (GVHD) prophylaxis of allogeneic hematopoietic cell transplantation (allo-HCT) for advanced myelofibrosis (MF) have not been fully elucidated. METHODS: Thirty-five patients with advanced MF were treated with reduced-intensity conditioning (RIC) allo-HCT. We searched for matched sibling donors first, followed by matched or mismatched unrelated donors and familial mismatched donors. Preconditioning regimen consisted of fludarabine (total 150 mg/m(2)) and busulfan (total 6.4 mg/kg) with total body irradiation ⩽400cGy. RESULTS: All showed engraftments, but four showed either leukemic relapse or delayed graft failure. Two-year overall survival (OS) and non-relapse mortality (NRM) was 60.0% and 29.9%, respectively. Acute GVHD was observed in 19 patients, and grade III-IV acute GVHD (eight grade III and four grade IV) was higher in human leukocyte antigen (HLA)-mismatched donor HCT compared with HLA-matched HCT (70% versus 20%). Chronic GVHD was observed in 16 patients, and a cumulative incidence of severe chronic GVHD was 33% in HLA-mismatched donor HCT and 7.7% in HLA-matched HCT. Significant hepatic GVHD was observed in nine patients (five acute, four chronic) and six of them died. Multivariate analysis revealed inferior OS in HLA-mismatched donor HCT (hazard ratio (HR) = 6.40, 95% confidence interval (CI) 1.6-25.7, p = 0.009) and in patients with high ferritin level at the time of pre-conditioning period (HR = 7.22, 95% CI 1.9-27.5, p = 0.004), which were related to higher incidence of hepatic GVHD with high NRM rate. CONCLUSION: RIC allo-HCT can be a valid choice providing graft-versus-fibrosis effect for advanced MF patients. However, HLA-mismatched donor and high pre-HCT ferritin level related to fatal hepatic GVHD should be regarded as poor-risk parameters. CI - (c) The Author(s), 2020. FAU - Yoon, Jae-Ho AU - Yoon JH AUID- ORCID: 0000-0002-2145-9131 AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Min, Gi June AU - Min GJ AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Park, Sung-Soo AU - Park SS AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Park, Silvia AU - Park S AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Lee, Sung-Eun AU - Lee SE AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Cho, Byung-Sik AU - Cho BS AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Kim, Yoo-Jin AU - Kim YJ AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Lee, Seok AU - Lee S AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Kim, Hee-Je AU - Kim HJ AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Min, Chang-Ki AU - Min CK AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Cho, Seok-Goo AU - Cho SG AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Lee, Jong Wook AU - Lee JW AUID- ORCID: 0000-0003-2949-4166 AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. FAU - Eom, Ki-Seong AU - Eom KS AD - Department of Hematology, Catholic Hematology Hospital and Leukemia Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul 06591, Republic of Korea. LA - eng PT - Journal Article DEP - 20200918 PL - England TA - Ther Adv Hematol JT - Therapeutic advances in hematology JID - 101549589 PMC - PMC7502801 OTO - NOTNLM OT - allogeneic OT - hematopoietic cell transplantation OT - myelofibrosis OT - reduced intensity conditioning COIS- Conflict of interest statement: The authors declare that there is no conflict of interest. EDAT- 2020/10/01 06:00 MHDA- 2020/10/01 06:01 PMCR- 2020/09/18 CRDT- 2020/09/30 06:13 PHST- 2020/02/13 00:00 [received] PHST- 2020/05/19 00:00 [accepted] PHST- 2020/09/30 06:13 [entrez] PHST- 2020/10/01 06:00 [pubmed] PHST- 2020/10/01 06:01 [medline] PHST- 2020/09/18 00:00 [pmc-release] AID - 10.1177_2040620720936935 [pii] AID - 10.1177/2040620720936935 [doi] PST - epublish SO - Ther Adv Hematol. 2020 Sep 18;11:2040620720936935. doi: 10.1177/2040620720936935. eCollection 2020.