Researchers studying outcomes of patients 70 years of age or older undergoing allogeneic hematopoietic cell transplantation (HCT) with a melphalan-based reduced-intensity conditioning regimen concluded that the regimen “is associated with acceptable toxicities and non-relapse mortality, lower incidence of relapse, and favorable overall and progression-free survival.”
The retrospective study analyzed the outcome of 53 consecutive patients aged 70 years and older who underwent allogeneic HCT at City of Hope in Duarte, Calif., between 2007 and 2016.
Patients had a median time to neutrophil engraftment of 15 days, and >95% of patients achieved complete donor chimerism within 6 weeks from HCT.
Outcomes at a median follow up of 31.1 months are shown in the table below.
| Outcome | Percent |
| 2-year OS | 68.9% |
| 2-year PFS | 63.8% |
| 2-year NRM | 17.0% |
| 1-year relapse CI | 17.0% |
| 2-year relapse CI | 19.3% |
| 100-day grade II-IV acute GVHD | 37.7% |
| 2-year CI chronic GVHD | 61.9% |
OS=overall survival, PFS=progression-free survival, NRM=non-relapse mortality, CI=cumulative incidence, GVHD=graft-versus-host disease
The study found that the only significant predictor for poor OS was high or very high disease risk index (DRI), and that transplant-related complications/morbidities observed in the older patient cohort did not differ from those commonly expected in younger patients treated with reduced-intensity HCT.
The researchers noted that chronologic age alone has not been clearly shown to be an independent poor prognostic indicator of allogeneic HCT outcomes, and that patients considering HCT should therefore undergo a comprehensive geriatric assessment, including evaluation of medical, psychosocial and functional capabilities.
Al Malki MM, et al. Biol Blood Marrow Transplant