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

Rice C, Eikema DJ, Marsh JCW, Knol C, Hebert K, Putter H, Peterson E, Deeg HJ, Halkes S, Pidala J, Anderlini P, Tischer J, Kroger N, Mcdonald A, Antin JH, Schaap NP, Hallek M, Einsele H, Mathews V, Kapoor N, Boelens JJ, Mufti GJ, Potter V, De La Tour RP, Eapen M, Dufour C (2019)

Publication Type: Journal article

Publication year: 2019

Journal

Book Volume: 25

Pages Range: 488-495

Journal Issue: 3

DOI: 10.1016/j.bbmt.2018.08.029

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.

Involved external institutions

European Society for Blood and Marrow Transplantation EBMT Netherlands (NL) King's College Hospital (KCH) United Kingdom (GB) Medical College of Wisconsin (MCW) United States (USA) (US) Leiden University Netherlands (NL) University Medical Centre Utrecht (UMC Utrecht) Netherlands (NL) Fred Hutchinson Cancer Research Center United States (USA) (US) H. Lee Moffitt Cancer Center & Research Institute United States (USA) (US) University of Texas MD Anderson Cancer Center United States (USA) (US) Klinikum der Universität München (Großhadern und Innenstadt) Germany (DE) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Netcare Pretoria East Hospital South Africa (ZA) Dana–Farber Cancer Institute United States (USA) (US) Radboud University Nijmegen Netherlands (NL) Universität zu Köln Germany (DE) Universitätsklinikum Würzburg Germany (DE) Christian Medical College & Hospital India (IN) Children's Hospital Los Angeles United States (USA) (US) Assistance Publique-Hôpitaux de Paris (AP-HP) France (FR) Istituto Giannina Gaslini Italy (IT)

How to cite

APA:

Rice, C., Eikema, D.-J., Marsh, J.C.W., Knol, C., Hebert, K., Putter, H.,... Dufour, C. (2019). Allogeneic Hematopoietic Cell Transplantation in Patients Aged 50Years or Older with Severe Aplastic Anemia. Biology of Blood and Marrow Transplantation, 25(3), 488-495. https://doi.org/10.1016/j.bbmt.2018.08.029

MLA:

Rice, Carmel, et al. "Allogeneic Hematopoietic Cell Transplantation in Patients Aged 50Years or Older with Severe Aplastic Anemia." Biology of Blood and Marrow Transplantation 25.3 (2019): 488-495.

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