title: Impact of age on outcomes after bone marrow transplantation for acquired aplastic anemia using HLA-matched sibling donors.
abstract: BACKGROUND
  Transplantation from an HLA-matched sibling is the treatment of choice for young patients with acquired severe aplastic anemia. For older patients, the acceptable upper age limit for transplantation as first-line treatment varies. The current analysis, therefore, sought to identify age or ages at transplantation at which survival differed.
  
  
  METHODS
  We studied the effect of patients' age, adjusting for other significant factors affecting outcomes, in 1307 patients with severe aplastic anemia after HLA-matched sibling transplantation using logistic and Cox regression analysis. Age categories (<20 years, 20-40 years, >40 years) were determined using Martingale residual plots for overall survival and categories based on differences in survival.
  
  
  RESULTS
  Patients aged over 40 years old were more likely to have had immunosuppressive therapy, a poor performance score and a longer interval between diagnosis and transplantation. Neutrophil recovery was similar in all age groups but patients aged over 40 years had a lower likelihood of platelet recovery compared to patients aged less than 20 years (OR 0.45, P=0.01) but not compared to those aged 20-40 years (OR 0.60, P=0.10). Compared to the risk of mortality in patients aged less than 20 years, mortality risks were higher in patients over 40 years old (RR 2.70, P<0.0001) and in those aged 20-40 years (RR 1.69, P<0.0001). The mortality risk was also higher in patients aged over 40 years than in those 20-40 years old (RR 1.60, P=0.008).
  
  
  CONCLUSIONS
  Mortality risks increased with age. Risks were also higher in patients with a poor performance score and when the interval between diagnosis and transplantation was longer than 3 months, implying earlier referral would be appropriate when this treatment option is being considered.
authors.affiliation: Princess Margaret Hospital, University of Toronto, Toronto, Canada.
authors.forename: Vikas
authors.initials: V
authors.lastname: Gupta
authors.forename: Mary
authors.initials: M
authors.lastname: Eapen
authors.forename: Ruta
authors.initials: R
authors.lastname: Brazauskas
authors.forename: Jeanette
authors.initials: J
authors.lastname: Carreras
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Hale
authors.forename: Osman
authors.initials: O
authors.lastname: Ilhan
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Passweg
authors.forename: Ollé
authors.initials: O
authors.lastname: Ringdén
authors.forename: Mitchell
authors.initials: M
authors.lastname: Sabloff
authors.forename: Hubert
authors.initials: H
authors.lastname: Schrezenmeier
authors.forename: Gerard
authors.initials: G
authors.lastname: Socié
authors.forename: Judith C W
authors.initials: JC
authors.lastname: Marsh
mesh_terms: D000328:Adult; D000367:Age Factors; D000741:Anemia, Aplastic / Q000601:surgery*; D001782:Blood Donors; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology; D006650:Histocompatibility Testing; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018570:Risk Assessment; D012307:Risk Factors; D035781:Siblings; D016896:Treatment Outcome; D055815:Young Adult