A study of 1,106 patients ≥70 years undergoing allogeneic hematopoietic cell transplantation (HCT) between 2000 and 2013 has found that overall survival has improved significantly and use of HCT in this patient cohort has increased over the last decade. Transplant outcomes were reported to CIBMTR (Center for International Blood and Marrow Transplant Research) from 103 U.S. centers. The majority (87%) of patients received reduced-intensity conditioning, and 82% had a Karnofsky performance score (KPS) of ≥80%. The most common disease indications were AML (54%), MDS/MPN (22%), and NHL (10%).
For patients ≥70 years, 2-year overall survival (OS) and progression-free survival (PFS) were significantly higher in 2012-2013 compared to 2000-2003: OS 36% vs. 28%, respectively (p=0.008); and PFS 30% vs. 21%, respectively (p=0.04). Two-year rates of transplant-related mortality (TRM) and relapse/progression did not change significantly over the study period.
The absolute number and proportion of allografts rose markedly over the past decade, from 62 (0.4% of all allogeneic HCT) in 2000-2003 to 471 (3.33% of all allogeneic HCT) in 2012-2013. Increase in HCT for MDS occurred after 2010 when Medicare implemented coverage for transplant in patients who enrolled in a CIBMTR clinical trial. The researchers conclude that research into methods to reduce TRM may further improve outcomes and encourage greater use of HCT in this age group.