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. 2019 Mar;25(3):488-495.
doi: 10.1016/j.bbmt.2018.08.029. Epub 2018 Sep 5.

Allogeneic Hematopoietic Cell Transplantation in Patients Aged 50Years or Older with Severe Aplastic Anemia

Carmel Rice  1 , Dirk-Jan Eikema  2 , Judith C W Marsh  3 , Cora Knol  4 , Kyle Hebert  5 , Hein Putter  6 , Eefke Peterson  7 , H Joachim Deeg  8 , Stijn Halkes  9 , Joseph Pidala  10 , Paolo Anderlini  11 , Johanna Tischer  12 , Nicolaus Kroger  13 , Andrew McDonald  14 , Joseph H Antin  15 , Nicolaas P Schaap  16 , Michael Hallek  17 , Herman Einsele  18 , Vikram Mathews  19 , Neena Kapoor  20 , Jaap-Jan Boelens  7 , Ghulam J Mufti  21 , Victoria Potter  1 , Régis Pefault de la Tour  22 , Mary Eapen  5 , Carlo Dufour  23
Affiliations

Allogeneic Hematopoietic Cell Transplantation in Patients Aged 50Years or Older with Severe Aplastic Anemia

Carmel Rice et al. Biol Blood Marrow Transplant. 2019 Mar.

Abstract

We report on 499 patients with severe aplastic anemia aged ≥ 50years who underwent hematopoietic cell transplantation (HCT) from HLA-matched sibling (n = 275, 55%) or HLA-matched (8/8) unrelated donors (n = 187, 37%) between 2005 and 2016. The median age at HCT was 57.8 years; 16% of patients were 65 to 77years old. Multivariable analysis confirmed higher mortality risks for patients with performance score less than 90% (hazard ratio [HR], 1.41; 95% confidence interval [CI], 1.03 to 1.92; P = .03) and after unrelated donor transplantation (HR, 1.47; 95% CI, 1 to 2.16; P = .05). The 3-year probabilities of survival for patients with performance scores of 90 to 100 and less than 90 after HLA-matched sibling transplant were 66% (range, 57% to 75%) and 57% (range, 47% to 76%), respectively. The corresponding probabilities after HLA-matched unrelated donor transplantation were 57% (range, 48% to 67%) and 48% (range, 36% to 59%). Age at transplantation was not associated with survival, but grades II to IV acute graft-versus-host disease (GVHD) risks were higher for patients aged 65years or older (subdistribution HR [sHR], 1.7; 95% confidence interval, 1.07 to 2.72; P = .026). Chronic GVHD was lower with the GVHD prophylaxis regimens calcineurin inhibitor (CNI) + methotrexate (sHR, .52; 95% CI, .33 to .81; P = .004) and CNI alone or with other agents (sHR, .27; 95% CI, .14 to .53; P < .001) compared with CNI + mycophenolate. Although donor availability is modifiable only to a limited extent, choice of GVHD prophylaxis and selection of patients with good performance scores are key for improved outcomes.

Keywords: Aplastic anemia; Hematopoietic cell transplant; Survival.

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Conflict of interest statement

Financial Disclosure Statement

Conflict of Interest: The authors declare no competing financial interests.

Figures

Figure 1.
Figure 1.. Factors affecting overall survival
Figure 1A shows OS by age <65 vs. ≥65 years, Figure 1B by stem cell source, Figure 1C performance status, and Figure 1D by donor type. The shaded regions indicate the corresponding 95% confidence intervals. Reported p-values are based on the log-rank test.
Figure 2.
Figure 2.. Factors affecting GVHD
Figure 2A shows acute GVHD incidence by age and Figure 2B chronic GVHD incidence by age. Figure 2C shows acute GVHD incidence by GVHD prophylaxis, and Figure 2D shows chronic GVHD incidence by GVHD prophylaxis. The shaded regions indicate the corresponding 95% confidence intervals. Reported p-values are based on Gray’s test. Of 116 patients who received CNI + other, 50 (43%) received alemtuzumab-based conditioning
Figure 3.
Figure 3.. Number of transplants
Number of transplants performed each year of the study by donor type: HLAidentical sibling and unrelated donor
See this image and copyright information in PMC

Comment in

References

    1. Artz AS. Biologic vs physiologic age in the transplant candidate. Hematology. 2016; 99:105–109 - PMC - PubMed
    1. Killick SB, Brown N, Cavenagh J, et al. British Society for Standards in Haematology. Guidelines for the diagnosis and management of adult aplastic anaemia. Brit J Haematol. 2016;172(2):187–207 - PubMed
    1. Tichelli A, Socie G, Henry-Amar M, et al. Effectiveness of immunosuppressive therapy in older patients with aplastic anemia. European Group for Blood and Marrow Transplantation Severe Aplastic Anaemia Working Party. Ann Intern Med. 1990; 130(3):193–201. - PubMed
    1. Tichelli A, Marsh JC. Treatment of aplastic anaemia in elderly patients aged >60 years. Bone Marrow Transplant. 2013; 48(2):180–2. - PubMed
    1. Kao SY, Xu W, Brandwein JM, et al. Outcomes of older patients (> or = 60 years) with acquired aplastic anaemia treated with immunosuppressive therapy. Brit. J. Haematol. 2008; 143(5): 738–743 - PubMed

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