title: Low transplant-related mortality with allogeneic stem cell transplantation in elderly patients.
abstract: Historically, age >60 years was considered a contraindication for allogeneic stem cell transplantation (allo-SCT). In recent years, elderly (>60 years) patients have become eligible for allo-SCT due to the application of reduced intensity conditioning (RIC). The present report summarizes our cumulative experience in a cohort of 17 elderly patients (age 60-67, median 62.5 years) with hematological malignancies treated with 18 allo-SCT procedures, mostly nonmyeloablative. In all, 14 patients received fludarabine and busulfan/busulfex regimen, three patients were conditioned with the fludarabine and low-dose TBI and one patient received busulfan alone. All patients displayed tri-lineage engraftment. The time to recovery of absolute neutrophil count >/=0.5 x 10(9)/l was 9-27 days (median 14 days). The time interval to platelet recovery >/=20 x 10(9)/l was 3-96 days (median 11 days). Veno-occlusive disease occurred only in 3/18 procedures and subsided with conventional treatment. Nonfatal transplant-related complications occurred in 6/18 (33.3%) procedures including: renal failure, arrhythmia, CNS bleeding, cystitis, typhlitis and gastrointestinal bleeding. Transplant-related mortality occurred in 6/18 (33.3%) episodes. Of the 17 patients, 12 (12/18 episodes) were discharged. Five of 17 (29%) patients survived (median follow-up 11 m, range 8-53 m). Our data suggest that RIC-allo-SCT may be safely applied in the elderly, suggesting that allogeneic immunotherapy may become an important tool for treatment of hematological malignancies without an age limit.
authors.affiliation: Department of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah - Hebrew University Medical Center, Jerusalem, Israel. shapiram@hadassah.org.il
authors.forename: M Y
authors.initials: MY
authors.lastname: Shapira
authors.forename: I B
authors.initials: IB
authors.lastname: Resnick
authors.forename: M
authors.initials: M
authors.lastname: Bitan
authors.forename: A
authors.initials: A
authors.lastname: Ackerstein
authors.forename: S
authors.initials: S
authors.lastname: Samuel
authors.forename: S
authors.initials: S
authors.lastname: Elad
authors.forename: S
authors.initials: S
authors.lastname: Miron
authors.forename: I
authors.initials: I
authors.lastname: Zilberman
authors.forename: S
authors.initials: S
authors.lastname: Slavin
authors.forename: R
authors.initials: R
authors.lastname: Or
mesh_terms: D000368:Aged; D002066:Busulfan / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D006085:Graft Survival; D006086:Graft vs Host Disease; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy; D006410:Hematopoiesis; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine