Increasing Use of Allogeneic Hematopoietic Cell Transplantation (HCT) in Patients Age 70 Years and Older: A CIBMTR Study of Trends and Outcomes

Abstract

Limited data exist regarding the use and outcomes of allogeneic HCT in adults 70 years and older. We aimed to describe trends and outcomes of allogeneic HCT in this population utilizing data reported to the CIBMTR from 2000-2013 from US centers. 1106 allogeneic HCT recipients 70 years (89% 70-74, 10% 75-79, <1% 80) from 103 centers are included. The most common disease indications were AML (54%), MDS/MPN (22%), and NHL (10%). 82% had KPS 80% and 46% had HCT-CI 3 (HCT-CI capture began in 2008). Unrelated donor (URD), HLA-identical sibling (MRD), HLAmismatched relative, and umbilical cord blood (UCB) were utilized in 61%, 26%, 7%, and 6%, respectively; the majority (87%) received reduced intensity conditioning. The absolute number and proportion of allografts for pts 70 years rose markedly over the past decade, from 62 (0.4% of all allogeneic HCT) in 2000-2003 to 471 (3.33% of all allogeneic HCT) in 2012-2013. HCT growth was seen mainly for AML and MDS (figure 1). Increase in HCT for MDS occurred after 2010 as transplants started to be covered by CMS. Table 1 and figure 1 display unadjusted 2-year outcomes. Among those Table 1 Univariate 2 year outcomes and 95% CI for each time period for patients 70 and older after allogeneic transplant

Reprint of: Aging: Treating the Older Patient

“…Patients 60 to 74 years of age achieved a favorable 2-year survival rate of 48% and a low nonrelapse mortality (NRM) rate of 14%. Registry data for AML and myelodysplastic syndrome patients 70 years and older using all donor sources and conditioning regimens showed 2-year survival rate of 38% and 2-year NRM rate of 30% [55]. Haploidentical and umbilical cord graft studies in older AML patients have been described [60][61][62].…”

“…The Center for International Blood and Marrow Transplant Research (CIBMTR) showed 22% of allogeneic transplant recipients were 60 years or older in 2007 to 2013 among common malignant conditions [54]. Likewise, US allografts for patients 70 years and older have risen 10-fold over the past decade, with AML as the leading indication ( Figure 1) [55]. Few older AML patients receive allogeneic transplant; a population study of AML diagnosed between 2000 and 2007 showed only 4% of AML patients 65 to 74 years underwent allografts [56].…”

“…Age-The preponderance of data supporting allografting for older AML patients has been in patients 65 years or less and sparse for 70 years and above [55,69]. Ideally, patients above 75 years of age would undergo transplant on clinical trials specifically addressing agerelated issues.…”

Biologic vs physiologic age in the transplant candidate

“…5 Patients in their 8th decade of life now represent the area of fastest growth of allogeneic and autologous grafts, and can have reasonable outcomes. 6,7 The European registry showed that from 2006 to 2010, autografts for myeloma in those $70 years represented 3% of transplants compared with only 1.1% a decade before. 7 Similarly, Muffly et al reported in abstract form that 3.3% of allogeneic HCTs in 2012 and 2013 derived from this age group vs 0.4% the decade before.…”

“…7 Similarly, Muffly et al reported in abstract form that 3.3% of allogeneic HCTs in 2012 and 2013 derived from this age group vs 0.4% the decade before. 6 Common transplant indications of MM, non-Hodgkin lymphoma, AML, and MDS peak in older adults and yet transplant is infrequently offered to patients $60 years. Oran and Weisdorf estimated among patients $65 years with AML, 2.4% underwent HLA typing and 0.8% pursued allografts.…”