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Research Spotlight
  • A safe and effective shared care approach after allogeneic HCT could be a new standard of care

    December 2022

  • Age alone should not be a barrier to HCT for adults with AML

    April 2022

  • Geriatric impairments in cancer patients affect caregiver health, QOL

    May 2019

  • Transplant Indications and Outcomes
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Related Resources

  • Access 2018 HCT Clinical Guidelines
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  • Learn more: Clinical Study for Medicare-Eligible Patients with MDS
  • View webinar: AML & MDS in Older Patients

Older Patient Outcomes

Research is showing that older chronological age per se is not a contraindication for hematopoietic cell transplantation (HCT), especially in patients with non-Hodgkin lymphomas (NHL) and acute myeloid leukemia (AML).

The number of hematopoietic cell transplants in older patients has grown in the last decade due to the use of reduced-intensity and non-myeloablative conditioning regimens, which use lower doses of chemotherapy and/or radiation. These less-intense regimens rely on immunosuppression to permit engraftment in the patient, and it is the donated allo-reactive T cells that then eradicate residual malignant cells through a graft-versus-tumor effect.

View the video below for the latest research affecting treatment decisions for older patients with AML who are considering HCT. 

Due to advances in treatment such as reduced-intensity conditioning regimens, the number of older patients receiving a blood stem cell transplant has increased significantly in recent years. In 2022, Be The Match® facilitated 3,895 transplants for patients over age 50. That represents 58% of 2022 transplants.

Advances

The use of less intense pre-transplant conditioning regimens, along with progress in post-transplant care, have allowed more patients >50 years or those with co-morbidities to undergo allogeneic HCT. Recent research has demonstrated that:

  • Chronological age per se should not serve as a barrier to transplant [2-5]
  • Reduced-intensity HCT using HLA-matched unrelated donors is feasible and effective in older patients with AML in CR1 [6]
  • Reduced-intensity HCT using HLA-matched unrelated and unrelated donors is feasible and effective in older patients with B-cell acute lymphoblastic leukemia in CR1 [7]
  • Older patients can achieve comparable quality of life when compared with younger patients [8]

Outcomes

Outcome data in this section have been prepared by CIBMTR® (Center for International Blood and Marrow Transplant Research), our research program.

Figure 2. MDS Survival, Unrelated HCT, by Age

MDS Survival, Unrelated HCT, by Age

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Figure 3. AML Survival, Unrelated HCT, Patients ≥55 years

AML Survival, Unrelated HCT, Patients ≥55 years

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References

  1. NMDP 2017 Fiscal Year Reports.
  2. Rashidi A, Ebadi E, Colditz GA, DiPersio JF. Outcomes of allogeneic stem cell transplantation in elderly patients with acute myeloid leukemia: A systematic review and meta-analysis. Biol Blood Marrow Transplant. 2016; 22(4): 651-657. Access
  3. Atallah E, Horowitz MM, Logan B, et al. Outcome of patients 65 years and older with myelodysplastic syndrome (MDS) receiving allogeneic hematopoietic stem cell transplantation compared to patients 55-64 years of age (abstract). Blood. 2015; 126(23): 193. Access
  4. McClune BL, Weisdorf DJ, Pedersen TL, et al. Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome. J Clin Oncol. 2010; 28(11): 1878-1887. Access
  5. Reshef R, Porter DL. Reduced-intensity conditioned allogeneic SCT in adults with AML. Bone Marrow Transplant. 2015; 50(6): 759-769. Access
  6. Devine SM, Owzar K, Blum W, et al. Phase II study of allogeneic transplantation for older patients with acute myeloid leukemia in first complete remission using a reduced-intensity conditioning regimen: Results from Cancer and Leukemia Group B 100103 (Alliance for Clinical Trials in Oncology)/Blood and Marrow Transplant Clinical Trials Network 0502. J Clin Oncol. 2015; 33(35): 4167-4175. Access
  7. Rosko AE, Wang H-L, de Lima M, et al. Reduced-intensity conditioned allograft yields favorable survival for older adults with B-cell acute lymphoblastic leukemia. Am J Hematol. 2017; 92(1): 42-49. Access
  8. Hamilton BK, Rybicki L, Dabney J, et al. Quality of life and outcomes in patients ≥60 years of age after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant. 2014; 49(11): 1426-1431. Access
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