Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States Journal Article

Authors: Muffly, L.; Pasquini, M. C.; Martens, M.; Brazauskas, R.; Zhu, X.; Adekola, K.; Aljurf, M.; Ballen, K. K.; Bajel, A.; Baron, F.; Battiwalla, M.; Beitinjaneh, A.; Cahn, J. Y.; Carabasi, M.; Chen, Y. B.; Chhabra, S.; Ciurea, S.; Copelan, E.; D’Souza, A.; Edwards, J.; Foran, J.; Freytes, C. O.; Fung, H. C.; Gale, R. P.; Giralt, S.; Hashmi, S. K.; Hildebrandt, G. C.; Ho, V.; Jakubowski, A.; Lazarus, H.; Luskin, M. R.; Martino, R.; Maziarz, R.; McCarthy, P.; Nishihori, T.; Olin, R.; Olsson, R. F.; Pawarode, A.; Peres, E.; Rezvani, A. R.; Rizzieri, D.; Savani, B. N.; Schouten, H. C.; Sabloff, M.; Seftel, M.; Seo, S.; Sorror, M. L.; Szer, J.; Wirk, B. M.; Wood, W. A.; Artz, A.
Article Title: Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States
Abstract: In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. The number and proportion of allografts performed in this population rose markedly over the past decade, accounting for 0.1% of transplants in 2000 to 3.85% (N = 298) in 2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications. Two-year OS and PFS significantly improved over time (OS: 26% [95% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant. © 2017, American Society of Hematology. All rights reserved.
Journal Title: Blood
Volume: 130
Issue: 9
ISSN: 0006-4971
Publisher: American Society of Hematology  
Date Published: 2017-08-31
Start Page: 1156
End Page: 1164
Language: English
DOI: 10.1182/blood-2017-03-772368
PROVIDER: scopus
PMCID: PMC5580273
PUBMED: 28674027
Notes: Article -- Export Date: 2 October 2017 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Sergio Andres Giralt
    516 Giralt