My brother has Myelofibrosis and needs a bone marrow transplant. He is 61 and has been hospitalized once.
His liver & spleen are massively enlarged . Does anyone know the rate of success for bone marrow transplants
in older patients? He is otherwise active, healthy, and seems much younger than 61.
Prognostication on, “the rate of success?” is a question that would best be answered by your brother’s hematologist/oncologist, taking into account all facts of his specific form of Myelofibrosis. His being “otherwise active, healthy, and young-looking” for his age” are all very positive factors, in his favor. The following, taken from a leading Textbook of Internal Medicine (Goldman) is somewhat technical but may help to answer some of your questions and his doctors will be able to answer the others.
Also, prognostic models have been developed for PMF that take into account severity of organ abnormalities and hematologic parameters. His physicians are likely to be familiar with such models.
Here is the excerpt from Goldman's:
Allogeneic Stem Cell Transplantation
The largest study of allogeneic stem cell transplantation in PMF was conducted by the Center for International Bone Marrow Transplant Research (CIBMTR) and included 289 subject with a variety of donor types and conditioning regimens. Five-year disease-free survival and treatment-related mortality were 33 and 35% for matched related transplants and 27 and 50% for unrelated transplants, respectively. Outcome was not favorably affected by reduced-intensity conditioning ( Chapter 181). In another reduced-intensity conditioning transplant study from the Chronic Leukemia Working Party of the European Group for Blood and Marrow Transplantation, 103 patients (median age, 55 years) with PMF or post-PV or post-ET myelofibrosis were prospectively studied, and 5-year disease-free survival was estimated at 51%. Chronic graft-versus-host disease ( Chapter 181) occurred in 49% of these patients, and relapse (29%) was predicted by high-risk disease and prior splenectomy. The chronic graft-versus-host disease and relapse rates for matched related transplants in the CIBMTR study were 40 and 32%, respectively, and a history of splenectomy did not affect outcome.
Considering the lack of effective drug therapy for PMF, the risk of transplant-related complications might be justified in patients whose median survival is expected to be less than 5 years and whose leukemia risk is greater than 20%. Using the age-adjusted dynamic prognostic model, this group includes high- or intermediate-2-risk patients, as well as those with either red cell transfusion dependence or an unfavorable karyotype (see Prognosis). In general, post-transplant outcome is poor in the presence of high-risk disease, advanced age, unrelated donor, or human leukocyte antigen (HLA) mismatch. More studies are needed to clarify the impact of pretransplant JAK2V617F presence or allele burden on transplant outcome, but the persistent presence of the mutation after transplantation predicts clinical relapse.
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