Allogeneic hematopoietic stem cell transplantation in patients 50 years of age and older.
OBJECTIVE
The population of elderly patients with hematologic malignancies is increasing and so will the activity of stem cell transplantation (SCT) in this population. The aim of this study was to analyze the toxicity and survival of allogeneic SCT in patients 50 years and older (elderly group), and compare the results with a standard adult population (young group).


METHODS
Thirty-two elderly patients (median age 52.5, range 50-59 years) and 97 young patients (median 32, range 20-40) received a myeloablative, allogeneic SCT from HLA-identical siblings at a single institution, and formed the basis of this retrospective study. The majority of transplants in both groups were performed with non-T-cell-depleted bone marrow, conditioned with busulfan + cyclophosphamide and received cyclosporine + methotrexate as graft-versus-host disease (GVHD) prophylaxis. The percentage of high-risk patients was nearly double in the elderly group (41% vs. 23%, p = 0.06).


RESULTS
We observed a low incidence of toxicities in the elderly group, including veno-occlusive disease, acute and chronic GVHD, transplant-related mortality, time to engraftment, and relapse incidence, without significant differences compared within the young group. The 3-year survival rates were not statistically different between the elderly and young groups: 51% vs. 55% for all patients; 87% vs. 69% in chronic myeloid leukemia; 79% vs. 62% in standard risk patients and 13% vs. 31% in high risk ones. In multivariate analyses no significant difference in overall survival was found between age groups.


CONCLUSIONS
According to our experience, age alone (between 50-59), should not be considered a contraindication to a conventional HLA identical sibling transplant.
de la Cámara
Rafael
R
Servicio de Hematología, Hospital de la Princesa, C/Diego de León 62, Madrid 28006, Spain. r.camara@retemail.es
Alonso
Arancha
A
Steegmann
Juan Luis
JL
Arranz
Reyes
R
Granados
Enrique
E
Rodríguez-Macías
Gabriela
G
Sanz-Rodríguez
Cesar
C
de Soria
Valle Gómez
VG
Figuera
Angela
A
Fernández-Rañada
José María
JM
D000328:Adult; D000375:Aging / Q000502:physiology*; D000075202:Contraindications; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006086:Graft vs Host Disease / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012008:Recurrence; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D015996:Survival Rate; D014184:Transplantation, Homologous / Q000009:adverse effects* / Q000401:mortality