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

Brian L. McClune, Daniel J. Weisdorf, Tanya L. Pedersen, Gisela Tunes Da Silva, Martin S. Tallman, Jorge Sierra, John DiPersio, Armand Keating, Robert P. Gale, Biju George, Vikas Gupta, Theresa Hahn, Luis Isola, Madan Jagasia, Hillard Lazarus, David Marks, Richard Maziarz, Edmund K. Waller, Chris Bredeson, Sergio Giralt

Research output: Contribution to journalArticle

300 Citations (Scopus)

Abstract

Purpose: Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) primarily afflict older individuals. Hematopoietic cell transplantation (HCT) is generally not offered because of concerns of excess morbidity and mortality. Reduced-intensity conditioning (RIC) regimens allow increased use of allogeneic HCT for older patients. To define prognostic factors impacting long-term outcomes of RIC regimens in patients older than age 40 years with AML in first complete remission or MDS and to determine the impact of age, we analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR). Patients and Methods: We reviewed data reported to the CIBMTR (1995 to 2005) on 1,080 patients undergoing RIC HCT. Outcomes analyzed included neutrophil recovery, incidence of acute or chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, disease-free survival (DFS), and overall survival (OS). Results: Univariate analyses demonstrated no age group differences in NRM, grade 2 to 4 acute GVHD, chronic GVHD, or relapse. Patients age 40 to 54, 55 to 59, 60 to 64, and ≥ 65 years had 2-year survival rates as follows: 44% (95% CI, 37% to 52%), 50% (95% CI, 41% to 59%), 34% (95% CI, 25% to 43%), and 36% (95% CI, 24% to 49%), respectively, for patients with AML (P = .06); and 42% (95% CI, 35% to 49%), 35% (95% CI, 27% to 43%), 45% (95% CI, 36% to 54%), and 38% (95% CI, 25% to 51%), respectively, for patients with MDS (P = .37). Multivariate analysis revealed no significant impact of age on NRM, relapse, DFS, or OS (all P > .3). Greater HLA disparity adversely affected 2-year NRM, DFS, and OS. Unfavorable cytogenetics adversely impacted relapse, DFS, and OS. Better pre-HCT performance status predicted improved 2-year OS. Conclusion: With these similar outcomes observed in older patients, we conclude that older age alone should not be considered a contraindication to HCT.

Original languageEnglish (US)
Pages (from-to)1878-1887
Number of pages10
JournalJournal of Clinical Oncology
Volume28
Issue number11
DOIs
StatePublished - Apr 10 2010
Externally publishedYes

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Myelodysplastic Syndromes
Cell Transplantation
Acute Myeloid Leukemia
Disease-Free Survival
Graft vs Host Disease
Survival
Mortality
Recurrence
Bone Marrow
Transplants
Research
Cytogenetics
Neutrophils
Multivariate Analysis
Survival Rate
Age Groups
Morbidity
Incidence

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Medicine(all)

Cite this

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. / McClune, Brian L.; Weisdorf, Daniel J.; Pedersen, Tanya L.; Da Silva, Gisela Tunes; Tallman, Martin S.; Sierra, Jorge; DiPersio, John; Keating, Armand; Gale, Robert P.; George, Biju; Gupta, Vikas; Hahn, Theresa; Isola, Luis; Jagasia, Madan; Lazarus, Hillard; Marks, David; Maziarz, Richard; Waller, Edmund K.; Bredeson, Chris; Giralt, Sergio.

In: Journal of Clinical Oncology, Vol. 28, No. 11, 10.04.2010, p. 1878-1887.

Research output: Contribution to journalArticle

McClune, BL, Weisdorf, DJ, Pedersen, TL, Da Silva, GT, Tallman, MS, Sierra, J, DiPersio, J, Keating, A, Gale, RP, George, B, Gupta, V, Hahn, T, Isola, L, Jagasia, M, Lazarus, H, Marks, D, Maziarz, R, Waller, EK, Bredeson, C & Giralt, S 2010, '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', Journal of Clinical Oncology, vol. 28, no. 11, pp. 1878-1887. https://doi.org/10.1200/JCO.2009.25.4821
McClune, Brian L. ; Weisdorf, Daniel J. ; Pedersen, Tanya L. ; Da Silva, Gisela Tunes ; Tallman, Martin S. ; Sierra, Jorge ; DiPersio, John ; Keating, Armand ; Gale, Robert P. ; George, Biju ; Gupta, Vikas ; Hahn, Theresa ; Isola, Luis ; Jagasia, Madan ; Lazarus, Hillard ; Marks, David ; Maziarz, Richard ; Waller, Edmund K. ; Bredeson, Chris ; Giralt, Sergio. / 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. In: Journal of Clinical Oncology. 2010 ; Vol. 28, No. 11. pp. 1878-1887.
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abstract = "Purpose: Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) primarily afflict older individuals. Hematopoietic cell transplantation (HCT) is generally not offered because of concerns of excess morbidity and mortality. Reduced-intensity conditioning (RIC) regimens allow increased use of allogeneic HCT for older patients. To define prognostic factors impacting long-term outcomes of RIC regimens in patients older than age 40 years with AML in first complete remission or MDS and to determine the impact of age, we analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR). Patients and Methods: We reviewed data reported to the CIBMTR (1995 to 2005) on 1,080 patients undergoing RIC HCT. Outcomes analyzed included neutrophil recovery, incidence of acute or chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, disease-free survival (DFS), and overall survival (OS). Results: Univariate analyses demonstrated no age group differences in NRM, grade 2 to 4 acute GVHD, chronic GVHD, or relapse. Patients age 40 to 54, 55 to 59, 60 to 64, and ≥ 65 years had 2-year survival rates as follows: 44{\%} (95{\%} CI, 37{\%} to 52{\%}), 50{\%} (95{\%} CI, 41{\%} to 59{\%}), 34{\%} (95{\%} CI, 25{\%} to 43{\%}), and 36{\%} (95{\%} CI, 24{\%} to 49{\%}), respectively, for patients with AML (P = .06); and 42{\%} (95{\%} CI, 35{\%} to 49{\%}), 35{\%} (95{\%} CI, 27{\%} to 43{\%}), 45{\%} (95{\%} CI, 36{\%} to 54{\%}), and 38{\%} (95{\%} CI, 25{\%} to 51{\%}), respectively, for patients with MDS (P = .37). Multivariate analysis revealed no significant impact of age on NRM, relapse, DFS, or OS (all P > .3). Greater HLA disparity adversely affected 2-year NRM, DFS, and OS. Unfavorable cytogenetics adversely impacted relapse, DFS, and OS. Better pre-HCT performance status predicted improved 2-year OS. Conclusion: With these similar outcomes observed in older patients, we conclude that older age alone should not be considered a contraindication to HCT.",
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T1 - 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

AU - McClune, Brian L.

AU - Weisdorf, Daniel J.

AU - Pedersen, Tanya L.

AU - Da Silva, Gisela Tunes

AU - Tallman, Martin S.

AU - Sierra, Jorge

AU - DiPersio, John

AU - Keating, Armand

AU - Gale, Robert P.

AU - George, Biju

AU - Gupta, Vikas

AU - Hahn, Theresa

AU - Isola, Luis

AU - Jagasia, Madan

AU - Lazarus, Hillard

AU - Marks, David

AU - Maziarz, Richard

AU - Waller, Edmund K.

AU - Bredeson, Chris

AU - Giralt, Sergio

PY - 2010/4/10

Y1 - 2010/4/10

N2 - Purpose: Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) primarily afflict older individuals. Hematopoietic cell transplantation (HCT) is generally not offered because of concerns of excess morbidity and mortality. Reduced-intensity conditioning (RIC) regimens allow increased use of allogeneic HCT for older patients. To define prognostic factors impacting long-term outcomes of RIC regimens in patients older than age 40 years with AML in first complete remission or MDS and to determine the impact of age, we analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR). Patients and Methods: We reviewed data reported to the CIBMTR (1995 to 2005) on 1,080 patients undergoing RIC HCT. Outcomes analyzed included neutrophil recovery, incidence of acute or chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, disease-free survival (DFS), and overall survival (OS). Results: Univariate analyses demonstrated no age group differences in NRM, grade 2 to 4 acute GVHD, chronic GVHD, or relapse. Patients age 40 to 54, 55 to 59, 60 to 64, and ≥ 65 years had 2-year survival rates as follows: 44% (95% CI, 37% to 52%), 50% (95% CI, 41% to 59%), 34% (95% CI, 25% to 43%), and 36% (95% CI, 24% to 49%), respectively, for patients with AML (P = .06); and 42% (95% CI, 35% to 49%), 35% (95% CI, 27% to 43%), 45% (95% CI, 36% to 54%), and 38% (95% CI, 25% to 51%), respectively, for patients with MDS (P = .37). Multivariate analysis revealed no significant impact of age on NRM, relapse, DFS, or OS (all P > .3). Greater HLA disparity adversely affected 2-year NRM, DFS, and OS. Unfavorable cytogenetics adversely impacted relapse, DFS, and OS. Better pre-HCT performance status predicted improved 2-year OS. Conclusion: With these similar outcomes observed in older patients, we conclude that older age alone should not be considered a contraindication to HCT.

AB - Purpose: Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) primarily afflict older individuals. Hematopoietic cell transplantation (HCT) is generally not offered because of concerns of excess morbidity and mortality. Reduced-intensity conditioning (RIC) regimens allow increased use of allogeneic HCT for older patients. To define prognostic factors impacting long-term outcomes of RIC regimens in patients older than age 40 years with AML in first complete remission or MDS and to determine the impact of age, we analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR). Patients and Methods: We reviewed data reported to the CIBMTR (1995 to 2005) on 1,080 patients undergoing RIC HCT. Outcomes analyzed included neutrophil recovery, incidence of acute or chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, disease-free survival (DFS), and overall survival (OS). Results: Univariate analyses demonstrated no age group differences in NRM, grade 2 to 4 acute GVHD, chronic GVHD, or relapse. Patients age 40 to 54, 55 to 59, 60 to 64, and ≥ 65 years had 2-year survival rates as follows: 44% (95% CI, 37% to 52%), 50% (95% CI, 41% to 59%), 34% (95% CI, 25% to 43%), and 36% (95% CI, 24% to 49%), respectively, for patients with AML (P = .06); and 42% (95% CI, 35% to 49%), 35% (95% CI, 27% to 43%), 45% (95% CI, 36% to 54%), and 38% (95% CI, 25% to 51%), respectively, for patients with MDS (P = .37). Multivariate analysis revealed no significant impact of age on NRM, relapse, DFS, or OS (all P > .3). Greater HLA disparity adversely affected 2-year NRM, DFS, and OS. Unfavorable cytogenetics adversely impacted relapse, DFS, and OS. Better pre-HCT performance status predicted improved 2-year OS. Conclusion: With these similar outcomes observed in older patients, we conclude that older age alone should not be considered a contraindication to HCT.

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