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Unrelated donor transplantation over the age of 55. Are we merely getting (b)older?

Leukemia volume 19, pages 31–33 (2005)Cite this article

In this issue, Shimoni et al1 report their outcomes with patients older than 55 undergoing allogeneic unrelated donor transplantation for hematologic malignancies. They conclude that, with reduced intensity conditioning, age over 55 no longer represents a contra-indication for unrelated donor transplantation.

How promising are these results? And what are the critical factors in transplantation technology that have rendered unrelated donor transplantation for older patients a realistic option? Unfortunately, the heterogeneity of the patient population, the short follow-up, and the retrospective nature of Shimoni's study preclude a precise estimate of cure rates, much less toxicity. The 1-year progression-free survival rate is an encouraging 43% and 17 patients remain alive and in remission, three with more than 20 months follow-up, suggesting that cure may at least occasionally be obtained. Enthusiasm is tempered by the six relapses with a median follow-up of only 10 months; cumulative treatment-related mortality is 39% at 1 year, with eight of 36 patients dying of toxicity, two of infections, and three of graft-versus-host disease. In addition, nine of 20 evaluable patients have chronic graft-versus-host disease. A limited multivariate analysis identifies chemotherapy sensitivity and the use of ‘modern conditioning regimens’ such as intravenous busulfan or treosulfan as predictors of a superior outcome, but the small sample size and retrospective nature significantly limit the validity of this analysis. The lymphoid diseases fared particularly poorly, but whether the poor outcome is related to disease histology, disease stage or poor performance status remains unclear.

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  1. Section of Hematology/Oncology, Department of Medicine and Cancer Research Center, University of Chicago, Chicago, IL, USA

    K van Besien, A Artz & W Stock

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Correspondence to K van Besien.

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van Besien, K., Artz, A. & Stock, W. Unrelated donor transplantation over the age of 55. Are we merely getting (b)older?. Leukemia 19, 31–33 (2005). https://doi.org/10.1038/sj.leu.2403594

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