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

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.

• Authors: Carmel Rice, Dirk-Jan Eikema, Judith C W Marsh, Cora Knol, Kyle Hebert, Hein Putter, Eefke Peterson, H Joachim Deeg, Stijn Halkes, Joseph Pidala, Paolo Anderlini, Johanna Tischer, Nicolaus Kroger, Andrew McDonald, Joseph H Antin, Nicolaas P Schaap, Michael Hallek, Herman Einsele, Vikram Mathews, Neena Kapoor, Jaap-Jan Boelens, Ghulam J Mufti, Victoria Potter, Régis Pefault de la Tour, Mary Eapen, Carlo Dufour
• Journal: Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation (Biol Blood Marrow Transplant) Vol. 25 Issue 3 Pg. 488-495 (03 2019) ISSN: 1523-6536 [Electronic] United States
• PMID: 30194027 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S.)
• Copyright: Copyright © 2018 American Society for Blood and Marrow Transplantation. All rights reserved.

Topics

• Age Factors
• Aged
• Anemia, Aplastic (mortality, therapy)
• Female
• Graft vs Host Disease (etiology, prevention & control)
• Hematopoietic Stem Cell Transplantation (adverse effects, methods, mortality)
• Histocompatibility
• Humans
• Male
• Middle Aged
• Premedication (methods)
• Survival Analysis
• Transplantation, Homologous
• Treatment Outcome