title: Outcomes in patients age 70 or older undergoing allogeneic hematopoietic stem cell transplantation for hematologic malignancies.
abstract: Allogeneic hematopoietic stem cell transplantation (HSCT) can achieve durable remissions in a number of patients with advanced hematologic malignancies. Little is known about the safety of HSCT in patients age 70 or older. Consecutive patients (n = 54) age 70 or older underwent HSCT between 2007 and 2012. Diseases included acute myelogenous leukemia (n = 25), myelodysplastic syndrome (n = 12), chronic lymphocytic leukemia (n = 5), non-Hodgkin lymphoma (n = 4), acute lymphoblastic leukemia (n = 3), myeloproliferative neoplasm (n = 4), and chronic myelogenous leukemia (n = 1). Median follow-up for survivors was 21 months. All patients received reduced-intensity conditioning regimens, primarily busulfan/fludarabine. All patients received unmanipulated peripheral blood stem cell grafts: 44 from 8/8 matched unrelated donors, 8 from matched related donors, and 2 from 7/8 matched unrelated donors. Graft-versus-host disease (GVHD) prophylaxis was calcineurin inhibitor-based in all patients. The median age at transplantation was 71 years (range, 70 to 76); the median HCT comorbidity index score was 1 (range, 0 to 5). Two patients died before hematopoietic recovery (1 with graft failure and 1 with disease progression), and 1 patient relapsed before hematopoietic recovery; otherwise, all engrafted with median donor chimerism of 94% at 1 month. Cumulative incidence of grades II to IV acute GVHD was 13% and of grades III to IV acute GVHD, 9.3%. At 2 years, the cumulative incidence of chronic GVHD was 36%, progression-free survival was 39%, overall survival was 39%, and relapse was 56%. Nonrelapse mortality was 3.7% at day +100 and 5.6% at 2 years. We conclude that allogeneic HSCT is a safe and effective option for carefully selected patients age 70 or older.
authors.affiliation: Bone Marrow Transplant Unit, Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Brunner
authors.forename: Haesook T
authors.initials: HT
authors.lastname: Kim
authors.forename: Erin
authors.initials: E
authors.lastname: Coughlin
authors.forename: Edwin P
authors.initials: EP
authors.lastname: Alyea
authors.forename: Philippe
authors.initials: P
authors.lastname: Armand
authors.forename: Karen K
authors.initials: KK
authors.lastname: Ballen
authors.forename: Corey
authors.initials: C
authors.lastname: Cutler
authors.forename: Bimalangshu R
authors.initials: BR
authors.lastname: Dey
authors.forename: Brett
authors.initials: B
authors.lastname: Glotzbecker
authors.forename: John
authors.initials: J
authors.lastname: Koreth
authors.forename: Steven L
authors.initials: SL
authors.lastname: McAfee
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Spitzer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Soiffer
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.forename: Vincent T
authors.initials: VT
authors.lastname: Ho
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Chen
mesh_terms: D000367:Age Factors; D000368:Aged; D005260:Female; D019337:Hematologic Neoplasms / Q000601:surgery*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D014184:Transplantation, Homologous; D016896:Treatment Outcome
keywords: Aged; Allogeneic transplantation; Graft versus host disease; Mortality; Relapse