title: Reduced-intensity conditioning for unrelated donor hematopoietic stem cell transplantation as treatment for myeloid malignancies in patients older than 55 years.
abstract: Hematopoietic stem cell transplantation from unrelated donors is an effective treatment for myeloid malignancies, but its use is usually restricted to young patients without comorbidities. The development of reduced-intensity preparative regimens has allowed the extension of this form of treatment to older and medically infirm patients. We assessed the outcomes of patients older than 54 years who received unrelated donor transplants for the treatment of myeloid malignancies in our institution. There were 29 patients (median age, 59 years) with advanced acute myeloid leukemia (n = 13), myelodysplastic syndrome (n = 7), and chronic myeloid leukemia (n = 9) included. With a median follow-up of 27 months, the probability of overall and event-free survival, and nonrelapse mortality at one year were 44%, 37%, and 55%, respectively. Grades II to IV acute graft-versus-host disease (GVHD) occurred in 41% of patients and chronic GVHD developed in 63% of patients surviving more than 100 days. Of the 11 survivors, 9 were interviewed and reported good quality of life after transplantation using the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT) questionnaire, with high scores in all dimensions. Unrelated donor transplantation is a treatment option for older patients with myeloid malignancies. The results in this cohort of patients are comparable with those reported in younger patients with similarly advanced disease.
authors.affiliation: Department of Blood and Marrow Transplantation, M. D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA.
authors.forename: Raymond
authors.initials: R
authors.lastname: Wong
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Giralt
authors.forename: Thomas
authors.initials: T
authors.lastname: Martin
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Couriel
authors.forename: Athanasios
authors.initials: A
authors.lastname: Anagnostopoulos
authors.forename: Chitra
authors.initials: C
authors.lastname: Hosing
authors.forename: Borje S
authors.initials: BS
authors.lastname: Andersson
authors.forename: Pedro
authors.initials: P
authors.lastname: Cano
authors.forename: Munir
authors.initials: M
authors.lastname: Shahjahan
authors.forename: Cindy
authors.initials: C
authors.lastname: Ippoliti
authors.forename: Elihu H
authors.initials: EH
authors.lastname: Estey
authors.forename: John
authors.initials: J
authors.lastname: McMannis
authors.forename: James L
authors.initials: JL
authors.lastname: Gajewski
authors.forename: Richard E
authors.initials: RE
authors.lastname: Champlin
authors.forename: Marcos
authors.initials: M
authors.lastname: de Lima
mesh_terms: D000367:Age Factors; D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006650:Histocompatibility Testing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism; D011379:Prognosis; D011788:Quality of Life; D013997:Time Factors; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome