Outcome of allogeneic stem cell transplantation for AML and myelodysplastic syndrome in elderly patients (⩾60 years)

Abstract

Allogeneic stem cell transplantation (SCT) remains the best curative option for patients with refractory AML or with high-risk myelodysplastic syndrome (MDS). For decades, age alone had been widely used as the primary criterion to assess eligibility for allogeneic SCT; however, prospective studies to evaluate allogeneic SCT in elderly patients are still limited. A total of 187 patients (median age of 64 years, range 60-77 years) with AML (87%) or MDS (13%) transplanted between 1999 and 2014 were included in this retrospective analysis. Relapse-free survival (RFS) and overall survival (OS) at 3 years were 32% (95% confidence interval (CI): 25-39%) and 35% (95%CI: 27-42%), respectively. Overall survival was 49% (95%CI: 35-64%) in AML patients who were transplanted in first complete remission (CR1), but even patients with active disease did benefit from transplantation, showing an OS at 3 years of 30% (95%CI: 20-40%). Multivariate analysis revealed disease- and patient-specific risk indices as independent prognostic factors for OS and non-relapse mortality (NRM). In conclusion, our monocenter results indicate that patients should not be generally withheld from allogeneic SCT because of age or disease status only. Specific risk models incorporating disease status and disease-specific risk factors at the time of transplantation as well as existing comorbidities are helpful tools to assess transplantation-associated risk factors of elderly patients.

Geriatric assessment and quality of life in older patients considered for allogeneic hematopoietic cell transplantation: a prospective risk factor and serial assessment analysis

“…Data showed a disease-free survival approaching 50% at 1 year in elderly patients with AML or MDS under RIC with Fludarabine, BCNU and Melphalan (FBM) [5][6][7][8]. Pohlen et al published retrospective data on AML/MDS patients above 60 years that showed excellent survival data in line with previously published reports [9]. Due to the promising results of large retrospective studies on a rapidly growing patient cohort >70 years that has been successfully transplanted since 2000 [10,11], alloHCT has been increasingly understood as feasible and effective.…”

Allogeneic Hematopoietic Cell Transplantation for Older Patients: Prognosis Determined by Disease Risk Index

“…Similar to our observation, a recent study by Pohlen et al showed 3 year OS of 43-54% for LR/IR DRI and 18-32% for HR/VHR DRI in 187 elderly patients (≥ 60 years) with AML or MDS. [8] Our study broadens Pohlen's findings to a larger range of hematologic malignancies and includes umbilical cord donor source for elderly patients, a population not included in their analysis. Although our study did not include large enough numbers of each DRI subgroup to make generalizations, particularly in high-risk and very-high risk DRI subgroups, our findings are consistent with a large CIBMTR registry report showing 2-year OS rates ranging from 64% for LR DRI group to 24% for VHR DRI group in adults of all ages with hematologic malignancies.…”

“…[4] [5] Several studies have shown that elderly patients ≥ 60 years of age have similar treatment-related mortality (TRM) and overall survival (OS) post-alloHCT compared to younger patients, with the majority of transplants utilizing reduced-intensity conditioning (RIC) regimens. [6][7][8][9]…”

How we treat older patients with acute myeloid leukaemia

“…For long‐term remission in fit older patients, allo‐SCT remains the most effective post‐remission strategy, with 38% 2‐year overall survival (OS) in CR1 for patients older than 69 years and a 3‐year OS of 49% for patients older than 60 years 10,11 …”