Improved Outcomes and Increased Use of HCT in Patients ≥70 Years

Overall and progression-free survival after allogeneic hematopoietic cell transplantation (HCT) in patients ≥70 years with hematologic malignancies increased significantly between 2000 and 2013, according to a multi-center study. The number of patients ≥70 years undergoing allogeneic HCT has also risen markedly during that time.

Researchers analyzed results of first allogeneic transplants from 103 U.S. transplant centers reported to CIBMTR® (Center for International Blood and Marrow Transplant Research®), specifically comparing transplant utilization and outcomes in 1,106 adults during two time periods: 2000-2007 and 2008-2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications.

Two-year post-transplant outcomes are shown in the table below.

 Outcome 2000-2007 2008-2013 p-value
 Overall survival 26% 39% <0.001
 Progression-free survival 22% 32% 0.003
 Transplant-related mortality 35% 33% 0.54
 Relapse/progression  43% 35% 0.04

A multivariate analysis revealed three adverse factors significantly associated with reduced overall survival in 2008-2013: higher comorbidity according to the HCT-comorbidity index (HCT-CI) ≥3 (HR=1.27, p=0.006), umbilical cord blood graft (HR=1.97, p=0.0002), and myeloablative conditioning (HR=1.61, p=0.0002). Age, disease status, disease and Karnofsky Performance Status did not significantly influence survival outcomes.

The researchers noted that the adverse biology of a disease associated with increasing age highlights the need to refer older patients early in the course of their disease for transplant consultation. They concluded that “select adults 70 years and older with hematologic malignancies should be considered for transplant.”

Muffly L, et al. Blood

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