Impact of toxicity on survival for older adult patients after CD34(+) selected allogeneic hematopoietic stem cell transplantation Journal Article

Authors: Shah, G. L.; Scordo, M.; Kosuri, S.; Herrera, D. A.; Cho, C.; Devlin, S. M.; Borrill, T.; Carlow, D. C.; Avecilla, S. T.; Meagher, R. C.; O'Reilly, R. J.; Jakubowski, A. A.; Papadopoulos, E. B.; Koehne, G.; Gyurkocza, B.; Castro-Malaspina, H.; Shaffer, B. C.; Perales, M. A.; Giralt, S. A.; Tamari, R.
Article Title: Impact of toxicity on survival for older adult patients after CD34(+) selected allogeneic hematopoietic stem cell transplantation
Abstract: Ex vivo CD34+ selection before allogeneic hematopoietic stem cell transplantation (allo-HCT) reduces graft-versus-host disease without increasing relapse but usually requires myeloablative conditioning. We aimed to identify toxicity patterns in older patients and the association with overall survival (OS) and nonrelapse mortality (NRM). We conducted a retrospective analysis of 200 patients who underwent CD34+ selection allo-HCT using the ClinicMACS® system between 2006 and 2012. All grade 3 to 5 toxicities by CTCAE v4.0 were collected. Eighty patients aged ≥ 60 years with a median age of 64 (range, 60 to 73) were compared with 120 patients aged < 60 years. Median follow-up in survivors was 48.2 months. OS and NRM were similar between ages ≥ 60 and <60, with 1-year OS 70% versus 78% (P =.07) and 1-year NRM 23% versus 13% (P =.38), respectively. In patients aged ≥ 60 the most common toxicities by day 100 were metabolic, with a cumulative incidence of 88% (95% CI, 78% to 93%), infectious 84% (95% CI, 73% to 90%), hematologic 80% (95% CI, 69% to 87%), oral/gastrointestinal (GI) 48% (95% CI, 36% to 58%), cardiovascular (CV) 35% (95% CI, 25% to 46%), and hepatic 25% (95% CI, 16% to 35%). Patients aged ≥ 60 had a higher risk of neurologic (HR, 2.63 [95% CI, 1.45 to 4.78]; P =.001) and CV (HR, 1.65 [95% CI, 1.04 to 2.63]; P =.03) toxicities but a lower risk of oral/GI (HR,.58 [95% CI,.41 to.83]; P =.003) compared with those aged < 60. CV, hepatic, neurologic, pulmonary, and renal toxicities remained independent risk factors for the risk of death and NRM in separate multivariate models adjusting for age and hematopoietic cell transplantation–specific comorbidity index. Overall, the toxicity of a more intense regimen is potentially balanced by the absence of toxicity related to methotrexate and calcineurin inhibitors in older patients. Prospective study of toxicities after allo-HCT in older patients is essential. © 2017 The American Society for Blood and Marrow Transplantation
Keywords: t cell depletion; gvhd; toxicities; transplant; allogeneic hematopoietic cell; geriatric oncology; ex vivo cd34 selection
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 24
Issue: 1
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2018-01-01
Start Page: 142
End Page: 149
Language: English
DOI: 10.1016/j.bbmt.2017.08.040
PROVIDER: scopus
PUBMED: 28951193
PMCID: PMC6731766
Notes: Article -- Export Date: 2 January 2018 -- Source: Scopus
Citation Impact
MSK Authors
  1. Sergio Andres Giralt
    746 Giralt
  2. Miguel-Angel Perales
    575 Perales
  3. Guenther Koehne
    193 Koehne
  4. Richard O'Reilly
    664 O'Reilly
  5. Sean McCarthy Devlin
    436 Devlin
  6. Christina Cho
    81 Cho
  7. Roni Tamari
    132 Tamari
  8. Michael Scordo
    136 Scordo
  9. Richard Charles Meagher
    43 Meagher
  10. Gunjan Lalitchandra Shah
    181 Shah
  11. Satyajit   Kosuri
    28 Kosuri
  12. Dean Christian Carlow
    30 Carlow
  13. Brian Carl Shaffer
    88 Shaffer
  14. Taylor Wray Borrill
    20 Borrill