Outcome of allogeneic stem cell transplantation for AML and myelodysplastic syndrome in elderly patients (⩾60 years).
Allogeneic stem cell transplantation (SCT) remains the best curative option for patients with refractory AML or with high-risk myelodysplastic syndrome (MDS). For decades, age alone had been widely used as the primary criterion to assess eligibility for allogeneic SCT; however, prospective studies to evaluate allogeneic SCT in elderly patients are still limited. A total of 187 patients (median age of 64 years, range 60-77 years) with AML (87%) or MDS (13%) transplanted between 1999 and 2014 were included in this retrospective analysis. Relapse-free survival (RFS) and overall survival (OS) at 3 years were 32% (95% confidence interval (CI): 25-39%) and 35% (95%CI: 27-42%), respectively. Overall survival was 49% (95%CI: 35-64%) in AML patients who were transplanted in first complete remission (CR1), but even patients with active disease did benefit from transplantation, showing an OS at 3 years of 30% (95%CI: 20-40%). Multivariate analysis revealed disease- and patient-specific risk indices as independent prognostic factors for OS and non-relapse mortality (NRM). In conclusion, our monocenter results indicate that patients should not be generally withheld from allogeneic SCT because of age or disease status only. Specific risk models incorporating disease status and disease-specific risk factors at the time of transplantation as well as existing comorbidities are helpful tools to assess transplantation-associated risk factors of elderly patients.
Department of Medicine A/Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
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M
Pohlen
Department of Medicine A/Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
C
C
Groth
Department of Medicine A/Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
T
T
Sauer
Institute of Biostatistics and Clinical Research, University Hospital of Muenster, Muenster, Germany.
D
D
Görlich
Department of Medicine A/Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
R
R
Mesters
Department of Medicine A/Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
C
C
Schliemann
Department of Medicine A/Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.|Translational Oncology, University Hospital Muenster, Muenster, Germany.|Cluster of Excellence EXC 1003, Cells in Motion, Muenster, Germany.
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G
Lenz
Department of Medicine A/Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.|Department of Medicine IV, Hematology and Oncology, University Hospital Halle, Halle, Germany.
C
C
Müller-Tidow
Department of Medicine A/Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
T
T
Büchner
Department of Medicine A/Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
W E
WE
Berdel
Department of Medicine A/Hematology and Oncology, University Hospital of Muenster, Muenster, Germany.
M
M
Stelljes
D000367:Age Factors; D000368:Aged; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D016019:Survival Analysis; D014184:Transplantation, Homologous; D016896:Treatment Outcome