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

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wallen, H. Articles by Gopal, A. K. Search for Related Content PubMed PubMed Citation Articles by Wallen, H. Articles by Gopal, A. K. Social Bookmarking                            What's this?

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				B. R. Dey, T. R. Spitzer, and R. P. Hasserjian Case 28-2009 -- A 68-Year-Old Man with Fatigue, Cough, and Peripheral-Blood Monocytosis N. Engl. J. Med., September 10, 2009; 361(11): 1099 - 1106. [Full Text] [PDF]

				H. D. Klepin and L. Balducci Acute Myelogenous Leukemia in Older Adults Oncologist, March 1, 2009; 14(3): 222 - 232. [Abstract] [Full Text] [PDF]

				M. A. Sekeres Treatment of older adults with acute myeloid leukemia: state of the art and current perspectives Haematologica, December 1, 2008; 93(12): 1769 - 1772. [Full Text] [PDF]

				J. Schetelig, M. Bornhauser, C. Schmid, B. Hertenstein, R. Schwerdtfeger, H. Martin, M. Stelljes, U. Hegenbart, K. Schafer-Eckart, M. Fussel, et al. Matched Unrelated or Matched Sibling Donors Result in Comparable Survival After Allogeneic Stem-Cell Transplantation in Elderly Patients With Acute Myeloid Leukemia: A Report From the Cooperative German Transplant Study Group J. Clin. Oncol., November 10, 2008; 26(32): 5183 - 5191. [Abstract] [Full Text] [PDF]

				A. A. Jakubowski, T. N. Small, J. W. Young, N. A. Kernan, H. Castro-Malaspina, K. C. Hsu, M.-A. Perales, N. Collins, C. Cisek, M. Chiu, et al. T cell depleted stem-cell transplantation for adults with hematologic malignancies: sustained engraftment of HLA-matched related donor grafts without the use of antithymocyte globulin Blood, December 15, 2007; 110(13): 4552 - 4559. [Abstract] [Full Text] [PDF]

				D. P. Steensma and A. Tefferi Anemia in the Elderly: How Should We Define It, When Does It Matter, and What Can Be Done? Mayo Clin. Proc., August 1, 2007; 82(8): 958 - 966. [Abstract] [Full Text] [PDF]

				D. Blaise, N. Vey, C. Faucher, and M. Mohty Current status of reduced intensity conditioning allogeneic stem cell transplantation for acute myeloid leukemia Haematologica, April 1, 2007; 92(4): 533 - 541. [Abstract] [Full Text] [PDF]

				J. H. Antin Reduced-Intensity Stem Cell Transplantation: "...whereof a little More than a little is by much too much." King Henry IV, part 1, I, 2 Hematology, January 1, 2007; 2007(1): 47 - 54. [Abstract] [Full Text] [PDF]