title: Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome.
abstract: PURPOSE Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) primarily afflict older individuals. Hematopoietic cell transplantation (HCT) is generally not offered because of concerns of excess morbidity and mortality. Reduced-intensity conditioning (RIC) regimens allow increased use of allogeneic HCT for older patients. To define prognostic factors impacting long-term outcomes of RIC regimens in patients older than age 40 years with AML in first complete remission or MDS and to determine the impact of age, we analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR). PATIENTS AND METHODS We reviewed data reported to the CIBMTR (1995 to 2005) on 1,080 patients undergoing RIC HCT. Outcomes analyzed included neutrophil recovery, incidence of acute or chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, disease-free survival (DFS), and overall survival (OS). RESULTS Univariate analyses demonstrated no age group differences in NRM, grade 2 to 4 acute GVHD, chronic GVHD, or relapse. Patients age 40 to 54, 55 to 59, 60 to 64, and > or = 65 years had 2-year survival rates as follows: 44% (95% CI, 37% to 52%), 50% (95% CI, 41% to 59%), 34% (95% CI, 25% to 43%), and 36% (95% CI, 24% to 49%), respectively, for patients with AML (P = .06); and 42% (95% CI, 35% to 49%), 35% (95% CI, 27% to 43%), 45% (95% CI, 36% to 54%), and 38% (95% CI, 25% to 51%), respectively, for patients with MDS (P = .37). Multivariate analysis revealed no significant impact of age on NRM, relapse, DFS, or OS (all P > .3). Greater HLA disparity adversely affected 2-year NRM, DFS, and OS. Unfavorable cytogenetics adversely impacted relapse, DFS, and OS. Better pre-HCT performance status predicted improved 2-year OS. CONCLUSION With these similar outcomes observed in older patients, we conclude that older age alone should not be considered a contraindication to HCT.
authors.affiliation: DO, University of Minnesota, Division of Hematology, Oncology and Transplantation, University of Minnesota, MMC 480, 420 Delaware St SE, Minneapolis, MN 55455, USA. bmcclune@umn.edu
authors.forename: Brian L
authors.initials: BL
authors.lastname: McClune
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Pedersen
authors.forename: Gisela
authors.initials: G
authors.lastname: Tunes da Silva
authors.forename: Martin S
authors.initials: MS
authors.lastname: Tallman
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.forename: John
authors.initials: J
authors.lastname: Dipersio
authors.forename: Armand
authors.initials: A
authors.lastname: Keating
authors.forename: Robert P
authors.initials: RP
authors.lastname: Gale
authors.forename: Biju
authors.initials: B
authors.lastname: George
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Theresa
authors.initials: T
authors.lastname: Hahn
authors.forename: Luis
authors.initials: L
authors.lastname: Isola
authors.forename: Madan
authors.initials: M
authors.lastname: Jagasia
authors.forename: Hillard
authors.initials: H
authors.lastname: Lazarus
authors.forename: David
authors.initials: D
authors.lastname: Marks
authors.forename: Richard
authors.initials: R
authors.lastname: Maziarz
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
authors.forename: Chris
authors.initials: C
authors.lastname: Bredeson
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D012074:Remission Induction; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome