title: Allogeneic hematopoietic stem-cell transplantation for patients 50 years or older with myelodysplastic syndromes or secondary acute myeloid leukemia.
abstract: OBJECTIVE
  This study was performed to examine the characteristics of transplant activity for patients with myelodysplastic syndromes (MDS) older than 50 years within the European Group for Blood and Marrow Transplantation, and to evaluate the factors predicting outcome within this group of patients.
  
  
  METHODS
  We performed a retrospective multicenter analysis of 1,333 MDS patients age 50 years or older who received transplantation within the EBMT since 1998. The median recipient age was 56 years, with 884 patients (66%) age 50 to 60 years and 449 (34%) patients older than 60 years. There were 811 HLA-matched sibling (61%) and 522 (39%) unrelated donor transplants. Five hundred patients (38%) received standard myeloablative conditioning (SMC), and 833 (62%) received reduced intensity conditioning (RIC).
  
  
  RESULTS
  The 4-year estimate for overall survival of the whole cohort was 31%. On multivariate analysis, use of RIC (hazard ratio [HR], 1.44; 95% CI, 1.13 to 1.84; P < .01) and advanced disease stage at transplantation (HR, 1.51; 95% CI, 1.18 to 1.93; P < .01) were associated with an increased relapse rate. In contrast, advanced disease stage at transplantation (HR, 1.43; 95% CI, 1.13 to 1.79; P = .01), use of an unrelated donor (P = .03), and RIC (HR, 0.79; 95% CI, 0.65 to 0.97; P = .03) were independent variables associated with nonrelapse mortality. Advanced disease stage at transplantation (HR, 1.55; 95% CI, 1.32 to 1.83; P < .01) was the major independent variable associated with an inferior 4-year overall survival.
  
  
  CONCLUSIONS
  Allogeneic hematopoietic stem-cell transplantation remains a potential curative therapeutic option for many older patients with MDS. In this analysis, disease stage at time of transplantation, but not recipient age or the intensity of the conditioning regimens, was the most important factor influencing outcomes.
authors.affiliation: Department of Haematological Medicine, Kings College London and Kings College Hospital, Denmark Hill, London, United Kingdom. ziyi.lim@kcl.ac.uk
authors.forename: Ziyi
authors.initials: Z
authors.lastname: Lim
authors.forename: Ronald
authors.initials: R
authors.lastname: Brand
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: Anja
authors.initials: A
authors.lastname: van Biezen
authors.forename: Jürgen
authors.initials: J
authors.lastname: Finke
authors.forename: Andrea
authors.initials: A
authors.lastname: Bacigalupo
authors.forename: Dietrich
authors.initials: D
authors.lastname: Beelen
authors.forename: Agnes
authors.initials: A
authors.lastname: Devergie
authors.forename: Emilio
authors.initials: E
authors.lastname: Alessandrino
authors.forename: Roel
authors.initials: R
authors.lastname: Willemze
authors.forename: Tapani
authors.initials: T
authors.lastname: Ruutu
authors.forename: Marc
authors.initials: M
authors.lastname: Boogaerts
authors.forename: Michele
authors.initials: M
authors.lastname: Falda
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Jouet
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kroger
authors.forename: Ghulam J
authors.initials: GJ
authors.lastname: Mufti
authors.forename: Theo M
authors.initials: TM
authors.lastname: De Witte
mesh_terms: D000367:Age Factors; D000368:Aged; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D012189:Retrospective Studies; D014184:Transplantation, Homologous