title: Impact of pre-transplant co-morbidities on outcome after alemtuzumab-based reduced intensity conditioning allo-SCT in elderly patients: a British Society of Blood and Marrow Transplantation study.
abstract: The advent of reduced intensity conditioning (RIC) regimens has permitted the extension of allo-SCT to selected patients into their eighth decade but GVHD remains a major cause of morbidity and mortality. Alemtuzumab is increasingly used to reduce the risk of severe GVHD, but there are concerns that T-cell depletion may compromise outcome particularly in older patients. We therefore studied the impact of pre-transplant factors on the outcome of 187 patients with a haematological malignancy over the age of 60 transplanted using an alemtuzumab-based RIC regimen of whom co-morbidity scoring was possible in 169. Of the patients, 120 had a haematopoietic cell transplantation co-morbidity index (HCT-CI) of 0 or 1 and 49 had a score of 2 or more. The 5-year OS was 33%. In multivariable analysis, OS was determined by co-morbidity score (P=0.001) and disease status at transplant (P=0.004) but not by patient age. Non-relapse mortality was determined by co-morbidity score (P=0.001). Two-year OS for patients with a HCT-CI of 0-1 was 59 versus 6% for patients with a higher score. Alemtuzumab-based RIC allografts can be delivered safely in patients aged over 60 but co-morbidity scoring is mandatory to identify patients who will benefit.
authors.affiliation: Heart of England NHS Trust, Birmingham, UK.
authors.forename: E
authors.initials: E
authors.lastname: Nikolousis
authors.affiliation: Centre for Clinical Haaematology, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Nagra
authors.affiliation: BSBMT Registry, Guy's Hospital, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Pearce
authors.affiliation: BSBMT Registry, Guy's Hospital, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Perry
authors.affiliation: BSBMT Registry, Guy's Hospital, London, UK.
authors.forename: K
authors.initials: K
authors.lastname: Kirkland
authors.affiliation: Nottingham University Hospitals, Nottingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Byrne
authors.affiliation: Royal Marsden NHS Foundation Trust, Surrey, Sutton, UK.
authors.forename: F
authors.initials: F
authors.lastname: Dignan
authors.affiliation: Manchester Royal Infirmary, Manchester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Tholouli
authors.affiliation: Leeds Teaching Hospitals, Leeds, UK.
authors.forename: M
authors.initials: M
authors.lastname: Gilleece
authors.affiliation: Nottingham University Hospitals, Nottingham, UK.
authors.forename: N
authors.initials: N
authors.lastname: Russell
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: T
authors.initials: T
authors.lastname: Littlewood
authors.affiliation: Centre for Clinical Haaematology, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: M
authors.initials: M
authors.lastname: Cook
authors.affiliation: Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: A
authors.initials: A
authors.lastname: Peniket
authors.affiliation: Royal Marsden NHS Foundation Trust, Surrey, Sutton, UK.
authors.forename: B E
authors.initials: BE
authors.lastname: Shaw
authors.affiliation: Leeds Teaching Hospitals, Leeds, UK.
authors.forename: G
authors.initials: G
authors.lastname: Cook
authors.affiliation: Centre for Clinical Haaematology, Queen Elizabeth Hospital, Birmingham, UK.
authors.forename: C
authors.initials: C
authors.lastname: Craddock
mesh_terms: D000368:Aged; D000074323:Alemtuzumab; D064591:Allografts; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D005260:Female; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012955:Societies, Medical; D015996:Survival Rate; D019172:Transplantation Conditioning; D006113:United Kingdom
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab