Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States

Abstract

In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. The number and proportion of allografts performed in this population rose markedly over the past decade, accounting for 0.1% of transplants in 2000 to 3.85% (N = 298) in 2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications. Two-year OS and PFS significantly improved over time (OS: 26% [95% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time ( = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; = .006), umbilical cord blood graft (HR, 1.97; = .0002), and myeloablative conditioning (HR, 1.61; = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.

Impact of Donor Type in Patients with AML Given Allogeneic Hematopoietic Cell Transplantation After Low-Dose TBI-Based Regimen

“…[1][2][3]. On the basis of discoveries in a preclinical canine model of transplantation (4), a truly nonmyeloablative conditioning regimen consisting of 2 Gy total body irradiation (TBI) with or without added fludarabine has been developed by the Seattle team (5)(6)(7)(8).…”

Distinct factors determine the kinetics of disease relapse in adults transplanted for acute myeloid leukaemia

“…The retrospective nature of this analysis limits its interpretation, and prospective studies will important to validate the observations we have made and limit selection bias. It is important also to note that the age of the cohort treated with IC in this study is lower than the transplant cohort, although this may be of less relevance given the increasing age at which allogeneic transplants can now be delivered with relative safety . Future studies on larger patient cohorts with more detailed molecular analyses will provide important information concerning whether specific molecular abnormalities predict either relapse risk or its kinetics.…”

Allogeneic stem cell transplantation for FLT3 mutated acute myeloid leukemia in first complete remission: does age really matter?

“…showed an increased number of transplants for older patients, 16 including alternative donor transplants, 17 with outcomes similar to those of HLA-matched donors. 18 Multiple studies have demonstrated that AHCT can provide long-term survival benefit in elderly AML patients with high risk for disease relapse, and advanced age per se should not be used as a contraindication for AHCT.…”