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. 2017 Aug 31;130(9):1156-1164.
doi: 10.1182/blood-2017-03-772368. Epub 2017 Jul 3.

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

Lori Muffly  1 , Marcelo C Pasquini  2 , Michael Martens  3 , Ruta Brazauskas  2   3 , Xiaochun Zhu  2 , Kehinde Adekola  4 , Mahmoud Aljurf  5 , Karen K Ballen  6 , Ashish Bajel  7 , Frederic Baron  8 , Minoo Battiwalla  9 , Amer Beitinjaneh  10 , Jean-Yves Cahn  11 , Mathew Carabasi  12 , Yi-Bin Chen  13 , Saurabh Chhabra  14 , Stefan Ciurea  15   16 , Edward Copelan  17 , Anita D'Souza  2 , John Edwards  18 , James Foran  19 , Cesar O Freytes  20 , Henry C Fung  21 , Robert Peter Gale  22 , Sergio Giralt  23 , Shahrukh K Hashmi  24   25 , Gerhard C Hildebrandt  26 , Vincent Ho  27 , Ann Jakubowski  23 , Hillard Lazarus  28 , Marlise R Luskin  29 , Rodrigo Martino  30 , Richard Maziarz  31 , Philip McCarthy  32 , Taiga Nishihori  33 , Rebecca Olin  34 , Richard F Olsson  35   36 , Attaphol Pawarode  37 , Edward Peres  38 , Andrew R Rezvani  1 , David Rizzieri  39 , Bipin N Savani  40 , Harry C Schouten  41 , Mitchell Sabloff  42 , Matthew Seftel  43 , Sachiko Seo  44 , Mohamed L Sorror  45   46 , Jeff Szer  47 , Baldeep M Wirk  48 , William A Wood  49 , Andrew Artz  50
Affiliations

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

Lori Muffly et al. Blood. .

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.

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Conflict of interest statement

Conflict-of-interest disclosure: The authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.
Annual number of HCTs in patients 70 years and older by indication. MPS, myeloproliferative syndrome.
Figure 2.
Figure 2.
Allogeneic HCT outcomes in adults 70 years and older. (A) OS after HCT in patients ≥70 years by year of transplant (2000-2007 vs 2008-2013). (B) Disease-free survival after HCT in patients ≥70 years with AML in remission, myelodysplasia, and chemotherapy-sensitive NHL from 2008 to 2013. (C) OS after HCT in patients ≥70 years with AML in remission, myelodysplasia, and chemotherapy-sensitive NHL from 2008 to 2013. (D) Disease-free survival after HCT in patients ≥70 years from 2008 to 2013 according to DRI. (E) OS after HCT in patients ≥70 years from 2008 to 2013 according to DRI.
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