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Blood, Vol. 93 No. 9 (May 1), 1999:
pp. 2831-2838
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
Philippe Guardiola,
Jeanne E. Anderson,
Giuseppe Bandini,
Francisco Cervantes,
Volker Runde,
William Arcese,
Andrea Bacigalupo,
Donna Przepiorka,
Margaret R. O'Donnell,
Paola Polchi,
Agnès Buzyn,
Laurent Sutton,
Dominique Cazals-Hatem,
George Sale,
Theo de Witte,
H. Joachim Deeg, and
Eliane Gluckman for the
International Collaboration for Transplantation in Agnogenic Myeloid
Metaplasia
From the Department of Hematology, Bone Marrow Transplant,
Hôpital Saint-Louis, Paris, France; the Division of Hematology,
Department of Medicine, University of Texas Health Science Center, San
Antonio, TX; the Instituto of Hematology "Seragnoli," Hospital
San Orsola, Bologna, Italy; the Department of Hematology, Hospital
Clinic, Barcelona, Spain; the Department of Bone Marrow
Transplantation, University Hospital, Essen, Germany; GITMO-Roma,
Ematologia, Universita "La Sapienza," Rome, Italy; the Department
of Hematology, Ospedale San Martino, Genova, Italy; the Department of
Hematology, M.D. Anderson Cancer Center, Houston, TX; the Department of
Hematology, The City of Hope, Duarte, CA; the Department of Hematology,
Pesaro Hospital, Pesaro, Italy; Service d'Hématologie Adultes,
Hôpital Necker, Paris, France; Service d'Hématologie,
Groupe Hospitalier "La Pitié-Salpétrière,"
Paris, France; Laboratoire d'Anatomopathologie, Hôpital Beaujon,
Clichy, France; the Division of Clinical Research, Fred Hutchinson
Cancer Research Center, Seattle, WA; and the Division of Hematology,
University Hospital St Radboud, Nijmegen, The Netherlands.
Agnogenic myeloid metaplasia (AMM) is a chronic
myeloproliferative disorder in which patients with poor prognostic
features, receiving conventional treatments, have a median survival of
less than 3 years. In this retrospective multicenter study, we analyze the results and try to define the indications for allogeneic stem cell
transplantation in AMM. From January 1979 to November 1997, 55 patients
with a median age of 42 years were transplanted from HLA-matched
related (n = 49) or alternative (n = 6) donors for AMM. A
multivariate analysis was conducted to identify factors associated with
posttransplant outcome. The median posttransplant follow-up was 36 months (range, 6 to 223). The 5-year probability of survival was 47% ± 8% for the overall group, and 54% ± 8% for patients
receiving an unmanipulated HLA-matched related transplant. The 1-year
probability of transplant-related mortality was 27% ± 6%.
Hemoglobin level  100 g/L and osteomyelosclerosis before transplant
adversely affected the outcome. The probability of developing grade
III-IV acute graft-versus-host disease (GVHD) was 33% ± 8%. Sixteen of 45 patients developed extensive chronic GVHD. At last
follow-up, 22 patients were in complete histohematologic remission.
Treatment failure was observed in 13 cases. Age at transplant and
karyotype were predictors of treatment failure. Allogeneic stem cell
transplantation is an effective treatment leading to cure in a
substantial number of patients with AMM. A better characterization of
the variables affecting the posttransplant outcome should lead to a
decreased transplant-related mortality and an improvement in these results.
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