Guidelines of Tefferi and Deeg for Therapy in a Patient with Myelofibrosis and Myeloid Metaplasia

Description

Tefferi and Deeg listed guidelines for allogenic hematopoietic stem cell transplantation (HSCT) in a patient with myelofibrosis wtih myeloid metaplasia. The authors are from Mayo Clinic in Rochester and Fred Hutchinson Cancer Research Center in Seattle.

Patient selection: primary myelofibrosis with myeloid metaplasia

Parameters:

(1) age

(2) risk based on estimated survival if untreated in years

Estimated Survival	Risk
> 10 years	low
5 - 10 years	intermediate
< 5 years	high

Risk	Age in Years	Therapy
low	NA	observation
intermediate	< 50 years	consider transplantation
	>= 50 years	experimental drug therapy
high	< 50 years	transplantation preferred therapy
	50 - 60 years	consider transplantation
	> 60 years	experimental drug therapy

where:

• Historically an age > 45 years is considered a poor outcome after HSCT, but current studies indicate that selected older patients may have a good outcome.

• Comorbid conditions may contribute to worsened survival after HSCT. Severe comorbid conditions may be a reason to consider experimental drug therapy.

• Patient choice and likelihood of compliance with the different regimens also will influence the choice of therapy. Poor compliance may favor experimental drug therapy.

This scheme may need to be adjusted based on outcome of trials using nonmyeloablative HSCT.

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Description

Specialty

ICD-10