Impact of age on outcomes after bone marrow transplantation for acquired aplastic anemia using HLA-matched sibling donors

Abstract

BackgroundTransplantation from an HLA-matched sibling is the treatment of choice for young patients with acquired severe aplastic anemia. For older patients, the acceptable upper age limit for transplantation as first-line treatment varies. The current analysis, therefore, sought to identify age or ages at transplantation at which survival differed. Design and MethodsWe studied the effect of patients' age, adjusting for other significant factors affecting outcomes, in 1307 patients with severe aplastic anemia after HLA-matched sibling transplantation using logistic and Cox regression analysis. Age categories (<20 years, 20-40 years, >40 years) were determined using Martingale residual plots for overall survival and categories based on differences in survival. ResultsPatients aged over 40 years old were more likely to have had immunosuppressive therapy, a poor performance score and a longer interval between diagnosis and transplantation. Neutrophil recovery was similar in all age groups but patients aged over 40 years had a lower likelihood of platelet recovery compared to patients aged less than 20 years (OR 0.45, P=0.01) but not compared to those aged 20-40 years (OR 0.60, P=0.10). Compared to the risk of mortality in patients aged less than 20 years, mortality risks were higher in patients over 40 years old (RR 2.70, P<0.0001) and in those aged 20-40 years (RR 1.69, P<0.0001). The mortality risk was also higher in patients aged over 40 years than in those 20-40 years old (RR 1.60, P=0.008). ConclusionsMortality risks increased with age. Risks were also higher in patients with a poor performance score and when the interval between diagnosis and transplantation was longer than 3 months, implying earlier referral would be appropriate when this treatment option is being considered.Key words: severe aplastic anemia, transplantation, patient age, HLA-identical sibling donor, overall survival. HLA-matched sibling donors. Haematologica 2010;95(12):2119-2125. doi:10.3324/haematol.2010 This is an open-access paper. © F e r r a t a S t o r t i F o u n d a t i o n Citation: Gupta V, Eapen M, Brazauskas R, Carreras J, Aljurf M, Gale RP, Hale GA, OIlhan O, Passweg JR, Ringdén O, Sabloff M, Schrezenmeier H, Socié G, and Marsh JCW. Impact of age on outcomes after bone marrow transplantation for acquired aplastic anemia using Impact of age on outcomes after bone marrow transplantation for acquired aplastic anemia using HLA-matched sibling donors

Good outcome of haploidentical hematopoietic SCT as a salvage therapy in children and adolescents with acquired severe aplastic anemia

“…The 5-year OS was 82% and 50% for those o20 years of age and those 440, respectively. 11 Children with hematological disorders had lower rates of TRM and trends towards better LFS and OS following ex vivo T-cell depletion haplo-HSCT in CIBMTR data. 12 Therefore children and adolescents with SAA were enrolled in our study.…”

The EBMT risk score

“…[16][17][18][19][20] This suggested that the role of the combined risk factors should also be tested to evaluate the predictive role of the EBMT risk score in other acquired malignant and non-malignant hematological disorders. An extensive analysis of the EBMT mega file on more than 50 000 allogeneic HSCT over a time period of more than 10 years confirmed the hypothesis (Figure 1).…”

Haploidentical hematopoietic stem cell transplantation for nonresponders to immunosuppressive therapy against acquired severe aplastic anemia

“…10,11 However, when the patient is older than 40 years, matched sibling donor HSCT can be considered as first-line therapy if suitable, 12 and matched unrelated donor HSCT can be considered a suitable second-line therapy if patients are younger than 50 (or 50-60 years old with good performance status) when initial immunosuppressive therapy shows no response. 8 It is unknown, however, whether SAA patients aged ⩾ 40 years can undergo haplo-HSCT.…”