Impact of age on outcomes of allogeneic hematopoietic stem cell transplantation with reduced intensity conditioning in elderly patients with acute myeloid leukemia

Abstract

Previous studies have repeatedly reported that increasing age is a significant risk factor for worse outcomes after allogeneic hematopoietic stem cell transplantation (allo-HSCT) among patients with acute myeloid leukemia (AML). However, more recent studies reported conflicting results regarding the association between age and outcomes in elderly patients. Therefore, we conducted a large-scale, nationwide retrospective study to examine the impact of age on outcomes of allo-HSCT with reduced intensity conditioning (RIC) for AML patients who were older than 50 years. Of the 757 patients, 89 patients (11.8%) were 50-54, 249 patients (32.9%) were 55-59, 301 patients (39.8%) were 60-64 and 118 patients (15.6%) were 65 years old. The 3-year overall survival (OS) (47.8, 45.2, 37.9, and 36.6% for patients aged 50-54, 55-59, 60-64, and 65 years, respectively, P 5 0.24) and nonrelapse mortality (NRM) (24.0, 22.8, 29.2, and 27.6% for patients aged 50-54, 55-59, 60-64, and 65 years, respectively, P 5 0.49) were not significantly different among the four age groups. Multivariate analysis revealed that increased age had no significant effect on OS or NRM after adjusting for covariates. These results suggested that advanced patient age is not a contraindication for RIC allo-HSCT in elderly AML patients.

Comparison of outcomes following transplantation with T-replete HLA-haploidentical donors using post-transplant cyclophosphamide to matched related and unrelated donors for patients with AML and MDS aged 60 years or older

“…Compared to other published data in similar patient population, our results show comparable survival and disease control rates [3-6, [22][23][24]. For example, a recent study of 187 patients with AML and MDS by Pohlen et al…”

Decitabine before Low-Dose Cytarabine-Based Chemotherapy Combined with Human Leukocyte Antigen–Mismatched Stem Cell Microtransplantation Improved Outcomes in Elderly Patients with Newly Diagnosed Acute Myeloid Leukemia

“…Older patients less often have HLA-matched related donors. Additionally, they have increased post-transplantation mortality caused by severe graft-versus-host disease (GVHD) [4][5][6]. To overcome this barrier, HLA-mismatched cellular therapy (stem cell [SC] microtransplantation [MST]) after conventional chemotherapy was developed to improve complete remission (CR) and OS and to reduce regimen-related toxicity compared to conventional chemotherapy [7].…”

Therapeutic Choice in Older Patients with Acute Myeloid Leukemia: A Matter of Fitness

“…Moreover, comprehensive geriatric assessment is currently under investigation in assessing patients' vulnerabilities before HSCT and could be a useful tool to select those patients more likely to benefit from the transplant procedure. Regarding transplant efficacy, Aoki et al reported encouraging disease-free and overall survival rates for selected patients older than 65 years, suggesting that age alone had no significant impact on transplant outcome [40]. Similarly, Kurosawa et al, in a registry survey of adults aged 50-70 years, in first complete remission (CR1), showed a longer 3-year OS for those who received HSCT rather than chemotherapy alone (62% vs. 51%, respectively), confirming a survival advantage of the transplant procedure, especially in high-risk patients [41].…”