Feasibility and recent improvement of autologous stem cell transplantation for acute myelocytic leukemia in patients over 60 years of age

Gorin, NC; Labopin, Myriam; Sierra, J; Fière, D; Rio, B.; Meloni, Giovanna; Sanz, Miguel-Ángel; Iriondo, A; Frassoni, Francesco

doi:10.1016/s0301-472x(00)00203-4

Cited by 3 publications

(5 citation statements)

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“…Furthermore, with a median follow-up of 2 years, we have not observed any transplant-related decline in performance status or late hematologic toxicity, even if 50% of patients were older than 65 years. As showed in Table VI, the feasibility of HDT has also been demonstrated in previously reports [18][19][20][21][22][23][24][25][26], but with a reported transplant related mortality (TRM) ranging from 0-17.6% (mean 9.3%). Furthermore, in some, but not all, studies, mucositis, a decline in performance status, and cardiovascular toxicity appeared more frequently in elderly patients.…”

Section: Discussionsupporting

confidence: 71%

“…This is the only way to address the question as to whether the potential morbidity and mortality and the high cost of HDT are counterbalanced by improved overall survival and qualityadjusted life years compared with alternative conventional treatment. 18 Gorin 19 Moreau 20 Stomatoullas 21 Sirohi 22 Olivieri 23 Jantunen 24 Sweetenham 25 Leger 26 This report Patients n 70 193 11 9 17 48 17 82 30 40 Median age 72 63 63 62 67 63 63 57 62.5 65 Disease AML -193 ---9 ----MM 70 ---17 16 --9 28 NHL --11 9 -22 17 82 21 12 Other -----1 …”

Section: Discussionmentioning

confidence: 97%

“…Badros et al 18 Gorin 19 Moreau 20 Stomatoullas 21 Sirohi 22 Olivieri 23 Jantunen 24 Sweetenham 25 Leger 26 This report Patients n 70 193 11 9 17 48 17 82 30 40 Median age 72 63 63 62 67 63 63 57 62.5 65 Disease AML -193 ---9 ----MM 70 ---17 16 --9 28 NHL --11 9 -22 17 82 21 12 Other -----1 ----Conditioning regimens CT/TBI…”

Section: Table VI Summary Of High-dose Therapy In the Elderly Reportmentioning

confidence: 99%

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Feasibility and toxicity of high‐dose therapy (HDT) supported by peripheral blood stem cells in elderly patients with multiple myeloma and non‐Hodgkin's lymphoma: Survey from a single institution

et al. 2003

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The aim of this retrospective study was to investigate the feasibility of high-dose therapy (HDT) followed by peripheral blood stem cell transplantation (PBSCT) in elderly patients with hematological malignancies. From April 1998 to November 2001, 40 elderly patients (defined as ≥60 years) with non-Hodgkin's lymphoma (12 patients) and multiple myeloma (28 patients) were evaluated. Seven lymphoma and one myeloma patients were in complete remission (CR), 27 in partial remission (PR), two had stable disease (SD), and three progressive disease (PD). The median age was 65 years (range 60-71). Thirty-nine patients were mobilized with chemotherapy plus granulocyte-colony stimulating factor (G-CSF) and one with G-CSF alone. Patients received HDT including melphalan alone in 32 cases or combined with other drugs in six and BEAM in two. The median number of collected CD34 + cells was 12.4 × 10 6 /kg (range 2.0-68.9). The median number of re-infused CD34 + cells was 9.9 × 10 6 /kg (range 2.0-68.9). All patients engrafted after PBSC and the median time to neutrophil recovery (N > 500/µl) and platelet recovery (PLT > 20,000/µl) was 8 days (range 5-18) and 6 days (range 5-18), respectively. Nonhematological toxicity was mild and no patient died from transplant-related toxicity (TRM). Median duration of hospitalization was 18 days (range 12-24). To date, 32 patients are alive and eight died from disease progression at a median follow-up interval of 24 months. HDT supported by PBSC is a feasible procedure in selected elderly patients, and an age of more than 60 years should not be considered a contraindication for HDT. Am.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 97%

Section: Table VI Summary Of High-dose Therapy In the Elderly Reportmentioning

confidence: 99%

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Feasibility and toxicity of high‐dose therapy (HDT) supported by peripheral blood stem cells in elderly patients with multiple myeloma and non‐Hodgkin's lymphoma: Survey from a single institution

et al. 2003

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“…Table 1 reviews the data for the studies that investigated the role of autologous stem cell transplantation specifically in the elderly AML patient. [37][38][39][40][41][42][43] Cahn et al 37 retrospectively compared European Group for Blood and Marrow Transplantation (EBMT) data for 111 CR1 AML patients older than 50 years versus 786 younger (median age 35 years) patients. Leukemia free survival (LFS) and OS rates at 4 years were significantly inferior in older patients, 34 versus 43% (P ¼ 0.004) and 35 versus 48% (P ¼ 0.004), respectively.…”

Section: Autologous Stem Cell Transplantation: Generalmentioning

confidence: 99%

“…These data suggested that elderly AML patients tolerated the autotransplants less well, yet some viable, older candidates can be identified and given transplant procedures successfully. A second retrospective registry data analysis by the Acute Leukemia Working Party of the EBMT published by Gorin et al 38 examined the feasibility of autotransplantation in AML patients older than 60 years. A total of 193 patients aged 60-75 (median age 63) years received autografts between the period 1984-1998, 147 of whom were in CR1.…”

Section: Autologous Stem Cell Transplantation: Generalmentioning

confidence: 99%

Blood and marrow transplantation in elderly acute myeloid leukaemia patients – older certainly is not better

Kiss

Sabry

Lazarus

et al. 2007

Bone Marrow Transplant

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Acute myeloid leukaemia in the elderly is a disease with distinct biological properties, commonly associated with leukaemic cell treatment resistance and with an increased number of high-risk features, including concomitant myelodysplasia and poor-risk cytogenetic abnormalities such as monosomy 5 and 7. Complete remission rates after standard induction chemotherapy in patients above age 60 years are less than 50%, with long-term survival rates below 10%. Post-remission stem cell transplant therapies have not been studied extensively. Autologous transplants can result in an acceptable 3-year leukaemia-free survival rate of up to 47%, yet this procedure is applicable only to a small minority of patients. Myeloablative allogeneic transplants similarly show feasibility in selected few patients and in general are very toxic. Non-myeloablative allogeneic transplants are associated with reduced toxicity, but are plagued by an increased relapse rate. The latter strategy appears promising, but must be validated in larger, multi-centre prospective trials, in which outcomes are compared to non-transplant approaches.

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Long-term Outcome of Autologous Transplantation of Peripheral Blood Progenitor Cells as Postremission Management of Patients ≥60 Years with Acute Myelogenous Leukemia

Lashkari¹,

Lowe²,

Collisson³

et al. 2006

Biology of Blood and Marrow Transplantation

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The optimal postremission treatment for elderly patients with acute myelogenous leukemia (AML) is presently unknown, but recent studies report the feasibility of autologous stem cell transplantation in this population. To better understand the long-term outcome of autologous transplantation in AML patients > or =60 years of age, we evaluated high-dose chemoradiotherapy preparative conditioning followed by transplantation of peripheral blood progenitor cells procured after a single cycle of cytarabine-based consolidation chemotherapy as postremission therapy in 27 patients aged 60 to 71 years (median age, 65 years) with newly diagnosed AML in first complete remission (CR). The median follow-up from CR for all patients was 13.6 months (range, 6.0-123.1 months). The median follow-up from remission for surviving patients was 81 months (range, 41.4-123.1 months). Seven patients are alive in continuous CR, 19 died from relapse, and 1 died as a result of treatment-related infection. Leukemia-free survival and overall survival are 10.3 and 13.4 months, respectively. Actuarial leukemia-free and overall survival at 3 years are 25% +/- 9% and 28% +/- 9%, respectively. Our results demonstrate that autologous transplantation of peripheral blood progenitor cells is well tolerated and feasible for patients > or =60 years of age with AML in first CR. Future investigation should focus on a randomized study evaluating a larger group of elderly patients in first CR comparing autologous stem cell transplantation with conventional cytarabine-based consolidation chemotherapy to identify the optimal postremission therapy.

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Feasibility and recent improvement of autologous stem cell transplantation for acute myelocytic leukemia in patients over 60 years of age

Cited by 3 publications

References 0 publications

Feasibility and toxicity of high‐dose therapy (HDT) supported by peripheral blood stem cells in elderly patients with multiple myeloma and non‐Hodgkin's lymphoma: Survey from a single institution

Feasibility and toxicity of high‐dose therapy (HDT) supported by peripheral blood stem cells in elderly patients with multiple myeloma and non‐Hodgkin's lymphoma: Survey from a single institution

Blood and marrow transplantation in elderly acute myeloid leukaemia patients – older certainly is not better

Long-term Outcome of Autologous Transplantation of Peripheral Blood Progenitor Cells as Postremission Management of Patients ≥60 Years with Acute Myelogenous Leukemia

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