Correspondence

Stem-Cell Transplantation for Myelofibrosis

N Engl J Med 2001; 344:775-776March 8, 2001

Article

To the Editor:

In response to Tefferi's excellent review of myelofibrosis (April 27 issue),1 Guardiola and colleagues have provided the results of allogeneic stem-cell transplantation in their patients with myelofibrosis (Aug. 31 issue).2 The authors refer to a previous report,3 which included data on 55 patients who underwent transplantation at a number of institutions, including the Fred Hutchinson Cancer Research Center; they then provide information on 11 new patients (with no indication as to where those patients underwent transplantation) and present a brief analysis of the results in all 66 patients. These results show an estimated five-year overall survival rate of 62 percent among patients who were younger than 45 years of age and 14 percent among patients who were 45 years of age or older. This outcome leads the authors to conclude that transplantation may not be the optimal strategy in patients who are 45 years of age or older. If transplantation is planned at all, it should be carried out at a younger age.

Although we agree that the rate of success of transplantation is higher among younger patients and those with a shorter duration of disease, in many cases myelofibrosis is diagnosed only when patients are in their 50s or 60s or even older. For these patients, the message conveyed by Guardiola and colleagues is misleading, since the data provided in the letter do not accurately reflect the results at all centers that perform transplantations in patients with myelofibrosis and that contributed information on patients to the original analysis.3 At the Fred Hutchinson Cancer Research Center, we have carried out transplantations for myelofibrosis in more than 50 patients (age range, 10 to 66 years; median, 43), including 23 patients who were 45 years of age or older. The three-year disease-free survival rate among these 23 patients is 63 percent, and only 1 patient died more than three years after transplantation, bringing the five-year disease-free survival rate to 50 percent. Although these results clearly leave room for improvement, they are considerably more encouraging than what Guardiola and colleagues suggest in their letter.2

H. Joachim Deeg, M.D.
Frederick R. Appelbaum, M.D.
Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024

3 References

1. 1

   Tefferi A. Myelofibrosis with myeloid metaplasia. N Engl J Med 2000;342:1255-1265
   Full Text | Web of Science | Medline

2. 2

   Guardiola P, Anderson JE, Gluckman E. Myelofibrosis with myeloid metaplasia. N Engl J Med 2000;343:659-659
   Full Text | Web of Science | Medline

3. 3

   Guardiola P, Anderson JE, Bandini G, et al. Allogeneic stem cell transplantation for agnogenic myeloid metaplasia: a European Group for Blood and Marrow Transplantation, Société Française de Greffe de Moelle, Gruppo Italiano per il Trapianto del Midollo Osseo, and Fred Hutchinson Cancer Research Center Collaborative Study. Blood 1999;93:2831-2838
   Web of Science | Medline

Citing Articles (5)

Citing Articles

1. 1

   William J. Hogan, Mark R. Litzow, Ayalew Tefferi. (2007) Allogeneic hematopoietic cell transplantation in myelofibrosis with myeloid metaplasia. Current Hematologic Malignancy Reports 2:1, 34-42
   CrossRef

2. 2

   John M McCarty. (2004) Transplant strategies for idiopathic myelofibrosis. Seminars in Hematology 41, 23-29
   CrossRef

3. 3

   David DINGLI, Ruben A. MESA, Ayalew TEFFERI. (2004) Myelofibrosis with Myeloid Metaplasia: New Developments in Pathogenesis and Treatment. Internal Medicine 43:7, 540-547
   CrossRef

4. 4

   Ayalew Teferri. (2003) Treatment approaches in myelofibrosis with myeloid metaplasia: The old and the new. Seminars in Hematology 40, 18-21
   CrossRef

5. 5

   Michelle A. Elliott, Ruben A. Mesa, Chin-Yang Li, C. Christopher Hook, Stephen M. Ansell, Ralph M. Levitt, Susan M. Geyer, Ayalew Tefferi. (2002) Thalidomide treatment in myelofibrosis with myeloid metaplasia. British Journal of Haematology 117:2, 288-296
   CrossRef