Outcomes of Nonmyeloablative HLA-Haploidentical Blood or Marrow Transplantation With High-Dose Post-Transplantation Cyclophosphamide in Older Adults.
OBJECTIVE
Recent advances in nonmyeloablative (NMA), related HLA-haploidentical blood or marrow transplantation (haplo-BMT) have expanded the donor pool. This study evaluated the effect of age on NMA haplo-BMT outcomes in patients age 50 to 75 years.


METHODS
A retrospective analysis was performed of 271 consecutive patients with hematologic malignancies, age 50 to 75 years, who received NMA, T-cell-replete haplo-BMT with high-dose post-transplantation cyclophosphamide.


RESULTS
The median age was 61 years, with 115 patients (42%) age 50 to 59, 129 (48%) age 60 to 69, and 27 (10%) age 70 to 75 years. Overall, 84% of patients had intermediate- or high-/very high-risk disease. The 6-month probabilities of grade 3 or 4 acute graft-versus-host disease (GVHD) and nonrelapse mortality (NRM) were 3% and 8%, respectively. Patients in their 50s, 60s, and 70s had 6-month NRM probabilities of 8%, 9%, and 7%, respectively (P=.20). With a median follow-up of 4 years, corresponding 3-year progression-free survival probabilities were 39%, 35%, and 33% (P=.65), and corresponding 3-year overall survival probabilities were 48%, 45%, and 44% (P=.66). Three-year progression-free survival probabilities were 40% in acute myeloid leukemia (n=65), 39% in aggressive non-Hodgkin lymphoma (n=83), and 37% in indolent or mantle-cell lymphoma (n=65). Older patient age was associated with a significantly higher risk of grade 2 to 4 acute GVHD but not grade 3 to 4 acute or chronic GVHD. No statistically significant associations were found between older age (relative to age 50 to 59 years or as a continuous variable) and NRM, relapse, or survival.


CONCLUSIONS
NMA haplo-BMT with post-transplantation cyclophosphamide has encouraging safety and survival outcomes in patients age 50 to 75 years. In patients otherwise fit for BMT, the results support consideration of this approach despite advanced age.
All authors: Johns Hopkins University, Baltimore, MD.
Yvette L
YL
Kasamon
All authors: Johns Hopkins University, Baltimore, MD.
Javier
J
Bolaños-Meade
All authors: Johns Hopkins University, Baltimore, MD.
Gabrielle T
GT
Prince
All authors: Johns Hopkins University, Baltimore, MD.
Hua-Ling
HL
Tsai
All authors: Johns Hopkins University, Baltimore, MD.
Shannon R
SR
McCurdy
All authors: Johns Hopkins University, Baltimore, MD.
Jennifer A
JA
Kanakry
All authors: Johns Hopkins University, Baltimore, MD.
Gary L
GL
Rosner
All authors: Johns Hopkins University, Baltimore, MD.
Robert A
RA
Brodsky
All authors: Johns Hopkins University, Baltimore, MD.
Karlo
K
Perica
All authors: Johns Hopkins University, Baltimore, MD.
B Douglas
BD
Smith
All authors: Johns Hopkins University, Baltimore, MD.
Douglas E
DE
Gladstone
All authors: Johns Hopkins University, Baltimore, MD.
Lode J
LJ
Swinnen
All authors: Johns Hopkins University, Baltimore, MD.
Margaret M
MM
Showel
All authors: Johns Hopkins University, Baltimore, MD.
William H
WH
Matsui
All authors: Johns Hopkins University, Baltimore, MD.
Carol Ann
CA
Huff
All authors: Johns Hopkins University, Baltimore, MD.
Ivan
I
Borrello
All authors: Johns Hopkins University, Baltimore, MD.
Keith W
KW
Pratz
All authors: Johns Hopkins University, Baltimore, MD.
Michael A
MA
McDevitt
All authors: Johns Hopkins University, Baltimore, MD.
Ivana
I
Gojo
All authors: Johns Hopkins University, Baltimore, MD.
Amy E
AE
Dezern
All authors: Johns Hopkins University, Baltimore, MD.
Satish
S
Shanbhag
All authors: Johns Hopkins University, Baltimore, MD.
Mark J
MJ
Levis
All authors: Johns Hopkins University, Baltimore, MD.
Leo
L
Luznik
All authors: Johns Hopkins University, Baltimore, MD.
Richard F
RF
Ambinder
All authors: Johns Hopkins University, Baltimore, MD.
Ephraim J
EJ
Fuchs
All authors: Johns Hopkins University, Baltimore, MD. rjjones@jhmi.edu.
Richard J
RJ
Jones
D000367:Age Factors; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage* / Q000009:adverse effects; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage* / Q000009:adverse effects; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D006680:HLA Antigens / Q000235:genetics* / Q000276:immunology; D006239:Haplotypes; D019337:Hematologic Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D019172:Transplantation Conditioning; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D006680:HLA Antigens; D003520:Cyclophosphamide