Barriers to Hematopoietic Cell Transplantation for Adults in the United States: A Systematic Review with a Focus on Age

Flannelly, Colin; Tan, Bryan E‐Xin; Tan, Jian Liang; McHugh, Colin; Sanapala, Chandrika; Lagu, Tara; Liesveld, Jane L.; Aljitawi, Omar S.; Becker, Michael W.; Mendler, Jason H.; Klepin, Heidi D.; Stock, Wendy; Wildes, Tanya M.; Artz, Andrew S.; Majhail, Navneet S.; Loh, Kah Poh

doi:10.1016/j.bbmt.2020.09.013

Cited by 34 publications

(10 citation statements)

References 57 publications

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“…Because HCT remains the only curative therapy for higher risk AML, \all patients with AML should be referred early to a transplant center for evaluation, donor identification, optimization of their disease and organ function, and for psychosocial support planning to maximize the rates of success. More effort should be directed towards investigating barriers to transplant and early referrals 4 . Women were also underrepresented in this cohort and reasons should be elucidated.…”

Section: Discussionmentioning

confidence: 99%

Age is no barrier for adults undergoing HCT for AML in CR1: contemporary CIBMTR analysis

Maakaron

Zhang

Abhyankar

et al. 2022

Bone Marrow Transplant

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Acute Myeloid Leukemia (AML) has a median age at diagnosis of 67 years. The most common curative therapy remains an allogeneic hematopoietic stem cell transplantation (HCT), yet it is complicated by treatment-related mortality (TRM) and ongoing morbidity including graft versus host disease (GVHD) that may impact survival, particularly in older patients. We examined the outcomes and predictors of success in 1,321 patients aged 60 years and older receiving a HCT for AML in first complete remission (CR1) from 2007–2017 and reported to the CIBMTR. Outcomes were compared in three age cohorts (60–64; 65–69; 70+). With median follow-up of nearly 3 years, patients aged 60–64 had modestly, though significantly better OS, DFS and lower TRM than those either 65–69 or 70+; cohorts with similar outcomes. Three-year OS for the 3 cohorts was 49.4%, 42.3%, and 44.7% respectively (p=0.026). TRM was higher with increasing age, cord blood as graft source and HCT-CI score of ≥ 3. Conditioning intensity was not a significant predictor of OS in the 60–69 cohort with 3-year OS of 46% for RIC and 49% for MAC (p=0.38); MAC was rarely used over age 70. There was no difference in the relapse rate, incidence of Grade III/IV acute GVHD, or moderate-severe chronic GVHD across the age cohorts. After adjusting for other predictors, age had a small effect on OS and TRM. High-risk features including poor cytogenetics and measurable residual disease (MRD) prior to HCT were each significantly associated with relapse and accounted for most of the adverse impact on OS and DFS. Age did not influence the incidence of either acute or chronic GVHD; while graft type and associated GVHD prophylaxis were most important. These data suggest that age alone is not a barrier to successful HCT for AML in CR1 and should not exclude patients from HCT. Efforts should focus on minimizing residual disease and better donor selection.

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Section: Discussionmentioning

confidence: 99%

Age is no barrier for adults undergoing HCT for AML in CR1: contemporary CIBMTR analysis

Maakaron

Zhang

Abhyankar

et al. 2022

Bone Marrow Transplant

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“…This patient’s surveillance bone marrow biopsies prior to his diagnosis of rectal cancer and during treatment, fortunately, did not indicate transformation to MDS or AML. Unfortunately, for many patients, there are many barriers to transplant [ 7 ] and ongoing, chronic management of diseases like congenital neutropenia may be the only option. This patient was able to complete care for his rectal cancer despite some financial barriers to care.…”

Section: Discussionmentioning

confidence: 99%

Individualized Treatment Approach for Rectal Adenocarcinoma in the Setting of Congenital Neutropenia

Forneris,

Chedid

2024

Cureus

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Congenial neutropenia is a rare genetic disorder that puts individuals at risk of life-threatening bacterial infections early in life, and the current standard of care includes the use of colony-stimulating factors or curative intent bone marrow transplant. Cancer treatment strategies that include surgery, chemotherapy, radiation, and immunotherapy present significant challenges to an individual with a baseline immunodeficiency as seen in this condition. Evidence-based national guidelines aid physicians and patients in moving through complex cancer care regimens. However, these are altered when the intensity of the patient's comorbidities puts them at increased risk of developing a potentially life-threatening infection. Here, we present a patient treated for rectal carcinoma in the setting of severe congenital neutropenia.

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“…A recent systematic review found older age, lower socioeconomic status, and non-White race to be associated with reduced access to HCT. 3 Outcomes of HCT vary according to the type and stage of the disease being treated, the overall health and comorbidities of the patient, the degree of HLA-mismatch between donor and recipient (for allogeneic HCT), and the source of the hematopoietic cells. 1 Hematopoietic cells can be obtained from peripheral blood, bone marrow, or umbilical cord blood (UCB).…”

Section: Overviewmentioning

confidence: 99%

NCCN Guidelines® Insights: Hematopoietic Cell Transplantation, Version 3.2022

Saad

Loren

Bolaños-Meade

et al. 2023

Journal of the National Comprehensive Cancer Network

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The NCCN Guidelines for Hematopoietic Cell Transplantation (HCT) provide an evidence- and consensus-based approach for the use of autologous and allogeneic HCT in the management of malignant diseases in adult patients. HCT is a potentially curative treatment option for patients with certain types of malignancies; however, recurrent malignancy and transplant-related complications often limit the long-term survival of HCT recipients. The purpose of these guidelines is to provide guidance regarding aspects of HCT, including pretransplant recipient evaluation, hematopoietic cell mobilization, and treatment of graft-versus-host disease—a major complication of allogeneic HCT—to enable the patient and clinician to assess management options in the context of an individual patient’s condition. These NCCN Guidelines Insights provide a summary of the important recent updates to the NCCN Guidelines for HCT, including the incorporation of a newly developed section on the Principles of Conditioning for HCT.

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Barriers to Hematopoietic Cell Transplantation for Adults in the United States: A Systematic Review with a Focus on Age

Cited by 34 publications

References 57 publications

Age is no barrier for adults undergoing HCT for AML in CR1: contemporary CIBMTR analysis

Age is no barrier for adults undergoing HCT for AML in CR1: contemporary CIBMTR analysis

Individualized Treatment Approach for Rectal Adenocarcinoma in the Setting of Congenital Neutropenia

NCCN Guidelines® Insights: Hematopoietic Cell Transplantation, Version 3.2022

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