Allogeneic hematopoietic stem cell transplantation in patients older than 65 years with acute myeloid leukemia and myelodysplastic syndrome: a 15-year experience

Abstract

Background. Median age of occurrence of acute myeloid leukemias (AML) and myelodisplastc syndromes (MDS) is 65 years and older. Nevertheless, the use of allogeneic stem cell transplant (allo-HCT) has been historically limited to younger population, namely due to excess in non-relapse-mortality (NRM) in olders.Methods. In the present study, we analyzed all consecutive patients aged ≥ 65y diagnosed with AML (71, 81%) or MDS (19, 19%) who received transplants from adult donors at our center from January 2005 to December 2019.Results. Median age was 68.29y (65.02-76.54), 26pts (29%) aged ≥ 70y. Thirty-three (37%) pts received a HLA-matched donor. Conditioning regimen was myeloablative in 46pts (51%). The 3-year overall survival (OS) was 53+/-6%, and disease free survival (DFS) 45+/-6% (Figure 1). Day-100 and 3-year NRM was 17+/-2% and 29+/-2%, respectively. The 3-year CI of relapse was 22+/-2%. Day-100 CI of aGvHD was 21+/-2% for grade II-IV, 14+/-1% for grade III-IV. The 3-year CI of cGvHD was 35+/-3%, extensive 20+/-2%.In multivariate analysis, the Karnofsky Performance Status (KPS) < 90% was associated with lower OS

Thiotepa-busulfan-fludarabine Compared to Treosulfan-based Conditioning for Haploidentical Transplant With Posttransplant Cyclophosphamide in Patients With Acute Myeloid Leukemia in Remission: A Study From the Acute Leukemia Working Party of the EBMT

“…Relapse incidence at 2 years was not statistically different between the 2 conditioning regimens, being 16% (95% CI, 9-24) in TBF and 18% (95% CI, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] 4; Figure 1). GRFS at 2 years did not differ as well, 54% (95% CI, 46-63) in TBF and 53% (95% CI, 43-63) in Treo group, respectively (HR, 1.04 [95% CI, 0.73-1.49]; P = 0.83).…”

“…ATG was administered in addition to PTCy as GVHD prophylaxis in 13% of TBF and 11% of Treo patients, respectively. Median follow-up was 15 (range, 12-24) and 18 (range, [14][15][16][17][18][19][20][21][22] months in TBF and Treo, respectively.…”

“…GRFS at 2 years did not differ as well, 54% (95% CI, 46-63) in TBF and 53% (95% CI, 43-63) in Treo group, respectively (HR, 1.04 [95% CI, 0.73-1.49]; P = 0.83). CRFS at 2 years was 28% (95% CI, [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] and 39% (95% CI, 29-49) in TBF and Treo, respectively (HR, 0.81 [95% CI, 0.58-1.14]; P = 0.23).…”

“…Treosulfan has been recently approved in Europe on the basis of the results of a randomized trial conducted on patients with AML and myelodysplastic syndrome (MDS) receiving MSD or UD HSCT 16 , 17 . Nevertheless, evidence from treosulfan‐based (Treo) preparatory regimens in haplo‐HSCT for AML is limited to data from single‐center experience 18 , 19 . Hence, we designed the present study to compare the outcomes of Treo with TBF conditioning in a cohort of patients receiving haplo‐HSCT with PTCy for AML in complete remission (CR).…”

“… 16 , 17 Nevertheless, evidence from treosulfan-based (Treo) preparatory regimens in haplo-HSCT for AML is limited to data from single-center experience. 18 , 19 Hence, we designed the present study to compare the outcomes of Treo with TBF conditioning in a cohort of patients receiving haplo-HSCT with PTCy for AML in complete remission (CR).…”