title: Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies.
abstract: BACKGROUND
  A minimally toxic nonmyeloablative regimen was developed for allogeneic hematopoietic cell transplantation (HCT) to treat patients with advanced hematologic malignancies who are older or have comorbid conditions.
  
  
  OBJECTIVE
  To describe outcomes of patients 60 years or older after receiving minimally toxic nonmyeloablative allogeneic HCT.
  
  
  METHODS
  From 1998 to 2008, 372 patients aged 60 to 75 years were enrolled in prospective clinical HCT trials at 18 collaborating institutions using conditioning with low-dose total body irradiation alone or combined with fludarabine, 90 mg/m(2), before related (n = 184) or unrelated (n = 188) donor transplants. Postgrafting immunosuppression included mycophenolate mofetil and a calcineurin inhibitor.
  
  
  METHODS
  Overall and progression-free survival were estimated by Kaplan-Meier method. Cumulative incidence estimates were calculated for acute and chronic graft-vs-host disease, toxicities, achievement of full donor chimerism, complete remission, relapse, and nonrelapse mortality. Hazard ratios (HRs) were estimated from Cox regression models.
  
  
  RESULTS
  Overall, 5-year cumulative incidences of nonrelapse mortality and relapse were 27% (95% CI, 22%-32%) and 41% (95% CI, 36%-46%), respectively, leading to 5-year overall and progression-free survival of 35% (95% CI, 30%-40%) and 32% (95% CI, 27%-37%), respectively. These outcomes were not statistically significantly different when stratified by age groups. Furthermore, increasing age was not associated with increases in acute or chronic graft-vs-host disease or organ toxicities. In multivariate models, HCT-specific comorbidity index scores of 1 to 2 (HR, 1.58 [95% CI, 1.08-2.31]) and 3 or greater (HR, 1.97 [95% CI, 1.38-2.80]) were associated with worse survival compared with an HCT-specific comorbidity index score of 0 (P = .003 overall). Similarly, standard relapse risk (HR, 1.67 [95% CI, 1.10-2.54]) and high relapse risk (HR, 2.22 [95% CI, 1.43-3.43]) were associated with worse survival compared with low relapse risk (P < .001 overall).
  
  
  CONCLUSIONS
  Among patients aged 60 to 75 years treated with nonmyeloablative allogeneic HCT, 5-year overall and progression-free survivals were 35% and 32%, respectively.
authors: Transplantation Biology Program, Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA. msorror@fhcrc.org
authors: Mohamed L
authors: ML
authors: Sorror
authors: Brenda M
authors: BM
authors: Sandmaier
authors: Barry E
authors: BE
authors: Storer
authors: Georg N
authors: GN
authors: Franke
authors: Ginna G
authors: GG
authors: Laport
authors: Thomas R
authors: TR
authors: Chauncey
authors: Edward
authors: E
authors: Agura
authors: Richard T
authors: RT
authors: Maziarz
authors: Amelia
authors: A
authors: Langston
authors: Parameswaran
authors: P
authors: Hari
authors: Michael A
authors: MA
authors: Pulsipher
authors: Wolfgang
authors: W
authors: Bethge
authors: Firoozeh
authors: F
authors: Sahebi
authors: Benedetto
authors: B
authors: Bruno
authors: Michael B
authors: MB
authors: Maris
authors: Andrew
authors: A
authors: Yeager
authors: Finn Bo
authors: FB
authors: Petersen
authors: Lars
authors: L
authors: Vindeløv
authors: Peter A
authors: PA
authors: McSweeney
authors: Kai
authors: K
authors: Hübel
authors: Marco
authors: M
authors: Mielcarek
authors: George E
authors: GE
authors: Georges
authors: Dietger
authors: D
authors: Niederwieser
authors: Karl G
authors: KG
authors: Blume
authors: David G
authors: DG
authors: Maloney
authors: Rainer
authors: R
authors: Storb
mesh_terms: D000367:Age Factors; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002986:Clinical Trials as Topic; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D014916:Whole-Body Irradiation
chemical_list: D000970:Antineoplastic Agents; D014740:Vidarabine; C024352:fludarabine