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What factors determine if an allogeneic stem cell transplant is recommended to treat myeloproliferative neoplasms?
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RubenMesaMD (Physician - Oncology - Hematology/Oncology (Verified) ) - 08 / 07 / 2012
A difficult question and a very personalized decision between a patient and their physician. In general, the discussion of bone marrow transplantation is limited to those individuals with myelofibrosis. It has not been thought that the severe risks that can come with bone marrow transplantation are appropriate for those individuals with earlier disease such as P vera and ET. There have been rare exceptions for people with exceeding difficult disease. Amongst patients with myelofibrosis, we typically look at several factors including the age of the patient, is there an available donor and, very importantly, the risk with the disease. What is the expected life expectancy with myelofibrosis and have used the different range of dynamic prognostic scoring models out there, including the DIPSS and the DIPSS plus that look at many factors to get a sense of how life threatening the disease is and we try to balance that against what are the expected outcomes with stem cell transplantation. The prognostic factors which are important are 1) age of the patient, particularly whether they are under or over age 65; whether they have anemia, a hemoglobin of less than 10, particularly whether they need blood transfusions as part of that; a white cell count over 25,000; significant constitutional symptoms, i.e. weight loss greater than 10%, severe bone pain, a low platelet count of less than 100,000, chromosomal changes in the bone marrow or evidence of movement toward acute leukemia. The more of these factors an individual has, the greater concern we have with their myelofibrosis, the stronger the case potentially for considering stem cell transplantation.
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