Originally published as JCO Early Release 10.1200/JCO.2005.05.694 on April 11 2005

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Ablative Allogeneic Hematopoietic Cell Transplantation in Adults 60 Years of Age and Older

From the Clinical Research Division, Fred Hutchinson Cancer Research Center, and the Departments of Medicine, Division of Medical Oncology, and Biostatistics, University of Washington, Seattle, WA

Address reprint requests to Herschel Wallen, MD, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D3-100, Seattle, WA 98109; email: hwallen{at}u.washington.edu

PURPOSE: To evaluate outcomes of ablative allogeneic hematopoietic cell transplantation (HCT) in older patients with hematologic malignancies.

PATIENTS AND METHODS: We treated 52 patients from 1979 to 2002 with a median age of 62.8 years (range, 60.1 to 67.8 years) using ablative preparative regimens followed by allogeneic HCT from sibling donors. Diagnoses included myelodysplastic syndrome (MDS; n = 35), chronic myeloid leukemia (CML; n = 8), acute myeloid leukemia (AML; n = 6), and other (n = 3). Conditioning regimens included cyclophosphamide (CY) and busulfan (BU) (67%), total-body irradiation and CY (21%), BU-fludarabine (10%), and CY (2%).

RESULTS: Eighteen (35%) of 52 patients are alive at a median of 4.6 years (range, 0.8 to 9.1 years) after transplantation. Median overall survival (OS) and progression-free survival were 300 and 218 days, respectively. Three-year OS and relapse rates are estimated to be 34% and 24%, respectively. Nonrelapse mortality (NRM) rates at 100 days and 3 years are estimated to be 27% and 43%, respectively. Grade 3 to 4 acute graft-versus-host disease (GVHD) occurred in 20% of patients, and chronic extensive GVHD was described in 53% of patients. Fourteen (40%) of 35 patients with MDS are alive at a median of 2.8 years (range, 0.8 to 8.2 years). Four of six patients with CML in chronic or accelerated phase are alive at a median of 6.9 years (range, 4.1 to 9.1 years) after transplantation. None of the patients with AML, CML in blast crisis, or other diagnoses have survived. Patients who underwent transplantation after 1993 had improved survival.

CONCLUSION: These data suggest that allogeneic HCT is feasible in selected patients 60 years of age, although novel methods to reduce NRM while maintaining efficacy are needed.

Supported by A Specialized Center for Research Grant from the Leukemia and Lymphoma Society (grant No. 7040-03); grant Nos. NIH PO1 CA1802, CA15704, CA78902, and HL 36444 from the National Institutes of Health; The Veteran's Administration PRIME program National Institutes of Health/National Cancer Institute Training grant No. T32 CA009515-20; The Westlund Foundation; and a gift from Frank and Betty Vandermeer.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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