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Reduced-intensity conditioning hematopoietic stem cell transplantation in patients over 60 years: hematologic malignancy outcomes are not impaired in advanced age.
Biol Blood Marrow Transplant. 2010 Jun; 16(6):792-800.BB

Abstract

Reduced-intensity-conditioning (RIC) hematopoietic stem cell transplantation (HSCT) is markedly underutilized in the elderly, in part because the impact of advanced age on outcomes is poorly understood. We retrospectively analyzed outcomes in 158 consecutive hematologic malignancy patients aged > or =60 years (median, 63 years; range: 60-71 years) undergoing fludarabine/busulfan-based RIC, with a median-follow-up of 34 months (range: 12.0-85.7). Multivariate analysis was undertaken for factors having an impact on outcome. For the patients aged > or =60 years, 2-year nonrelapse mortality (NRM) and relapse was 10% and 54.6%, respectively. Two-year overall and progression-free survival (OS, PFS) was 46% and 35%, respectively. Grade II-IV acute and chronic graft-versus-host disease (aGVHD, cGVHD) incidence was 19.6% and 45.9%, respectively. Comparing 110 patients aged 60-64 years versus 48 patients aged > or =65 years, 2-year NRM and relapse was 10.5% versus 8.3% (P = .84) and 53.5% versus 56.3% (P = .31), respectively. Grade II-IV aGVHD and cGVHD incidence was 19.1% versus 22.9% (P = .52) and 51.8% versus 32.5% (P = .01), respectively. Two-year OS and PFS was 49% versus 41% (P = .11) and 36% versus 35% (P = .24), respectively. In a multivariate Cox-model, high-risk disease associated with poorer PFS (hazard ratio [HR] = 2.1, P = .01) and OS (HR = 1.84, P = .03); acute myelogenous leukemia/myelodysplastic syndrome diagnosis (HR = 1.66, P = .03) and matched-related donor (HR = 1.62, P = .03) associated with poorer PFS. RIC HSCT is well tolerated, with reasonable survival in elderly patients. Age is not associated with impaired outcomes. HSCT should not be excluded solely based on advanced patient age.

Authors+Show Affiliations

Division of Hematologic Malignancies, Dana Farber Cancer Institute, Boston, Massachusetts 02115, USA. john_koreth@dfci.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

20074656

Citation

Koreth, John, et al. "Reduced-intensity Conditioning Hematopoietic Stem Cell Transplantation in Patients Over 60 Years: Hematologic Malignancy Outcomes Are Not Impaired in Advanced Age." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 16, no. 6, 2010, pp. 792-800.
Koreth J, Aldridge J, Kim HT, et al. Reduced-intensity conditioning hematopoietic stem cell transplantation in patients over 60 years: hematologic malignancy outcomes are not impaired in advanced age. Biol Blood Marrow Transplant. 2010;16(6):792-800.
Koreth, J., Aldridge, J., Kim, H. T., Alyea, E. P., Cutler, C., Armand, P., Ritz, J., Antin, J. H., Soiffer, R. J., & Ho, V. T. (2010). Reduced-intensity conditioning hematopoietic stem cell transplantation in patients over 60 years: hematologic malignancy outcomes are not impaired in advanced age. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 16(6), 792-800. https://doi.org/10.1016/j.bbmt.2009.12.537
Koreth J, et al. Reduced-intensity Conditioning Hematopoietic Stem Cell Transplantation in Patients Over 60 Years: Hematologic Malignancy Outcomes Are Not Impaired in Advanced Age. Biol Blood Marrow Transplant. 2010;16(6):792-800. PubMed PMID: 20074656.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reduced-intensity conditioning hematopoietic stem cell transplantation in patients over 60 years: hematologic malignancy outcomes are not impaired in advanced age. AU - Koreth,John, AU - Aldridge,Julie, AU - Kim,Haesook T, AU - Alyea,Edwin P,3rd AU - Cutler,Corey, AU - Armand,Philippe, AU - Ritz,Jerome, AU - Antin,Joseph H, AU - Soiffer,Robert J, AU - Ho,Vincent T, Y1 - 2010/01/13/ PY - 2009/11/30/received PY - 2009/12/31/accepted PY - 2010/1/16/entrez PY - 2010/1/16/pubmed PY - 2011/1/14/medline SP - 792 EP - 800 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 16 IS - 6 N2 - Reduced-intensity-conditioning (RIC) hematopoietic stem cell transplantation (HSCT) is markedly underutilized in the elderly, in part because the impact of advanced age on outcomes is poorly understood. We retrospectively analyzed outcomes in 158 consecutive hematologic malignancy patients aged > or =60 years (median, 63 years; range: 60-71 years) undergoing fludarabine/busulfan-based RIC, with a median-follow-up of 34 months (range: 12.0-85.7). Multivariate analysis was undertaken for factors having an impact on outcome. For the patients aged > or =60 years, 2-year nonrelapse mortality (NRM) and relapse was 10% and 54.6%, respectively. Two-year overall and progression-free survival (OS, PFS) was 46% and 35%, respectively. Grade II-IV acute and chronic graft-versus-host disease (aGVHD, cGVHD) incidence was 19.6% and 45.9%, respectively. Comparing 110 patients aged 60-64 years versus 48 patients aged > or =65 years, 2-year NRM and relapse was 10.5% versus 8.3% (P = .84) and 53.5% versus 56.3% (P = .31), respectively. Grade II-IV aGVHD and cGVHD incidence was 19.1% versus 22.9% (P = .52) and 51.8% versus 32.5% (P = .01), respectively. Two-year OS and PFS was 49% versus 41% (P = .11) and 36% versus 35% (P = .24), respectively. In a multivariate Cox-model, high-risk disease associated with poorer PFS (hazard ratio [HR] = 2.1, P = .01) and OS (HR = 1.84, P = .03); acute myelogenous leukemia/myelodysplastic syndrome diagnosis (HR = 1.66, P = .03) and matched-related donor (HR = 1.62, P = .03) associated with poorer PFS. RIC HSCT is well tolerated, with reasonable survival in elderly patients. Age is not associated with impaired outcomes. HSCT should not be excluded solely based on advanced patient age. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/20074656/Reduced_intensity_conditioning_hematopoietic_stem_cell_transplantation_in_patients_over_60_years:_hematologic_malignancy_outcomes_are_not_impaired_in_advanced_age_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(10)00004-2 DB - PRIME DP - Unbound Medicine ER -