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Conditioning

Impact of pre-transplant co-morbidities on outcome after alemtuzumab-based reduced intensity conditioning allo-SCT in elderly patients: A British Society of Blood and Marrow Transplantation study

Bone Marrow Transplantation volume 50, pages 82–86 (2015)Cite this article

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Abstract

The advent of reduced intensity conditioning (RIC) regimens has permitted the extension of allo-SCT to selected patients into their eighth decade but GVHD remains a major cause of morbidity and mortality. Alemtuzumab is increasingly used to reduce the risk of severe GVHD, but there are concerns that T-cell depletion may compromise outcome particularly in older patients. We therefore studied the impact of pre-transplant factors on the outcome of 187 patients with a haematological malignancy over the age of 60 transplanted using an alemtuzumab-based RIC regimen of whom co-morbidity scoring was possible in 169. Of the patients, 120 had a haematopoietic cell transplantation co-morbidity index (HCT-CI) of 0 or 1 and 49 had a score of 2 or more. The 5-year OS was 33%. In multivariable analysis, OS was determined by co-morbidity score (P=0.001) and disease status at transplant (P=0.004) but not by patient age. Non-relapse mortality was determined by co-morbidity score (P=0.001). Two-year OS for patients with a HCT-CI of 0–1 was 59 versus 6% for patients with a higher score. Alemtuzumab-based RIC allografts can be delivered safely in patients aged over 60 but co-morbidity scoring is mandatory to identify patients who will benefit.

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Acknowledgements

The hard work of the data managers at the contributing transplant centres is gratefully acknowledged. The work of the BSBMT registry was originally supported by a grant from Leukaemia and Lymphoma Research which is gratefully acknowledged.

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Authors and Affiliations

  1. Heart of England NHS Trust, Birmingham, UK

    E Nikolousis

  2. Centre for Clinical Haaematology, Queen Elizabeth Hospital, Birmingham, UK

    S Nagra, M Cook & C Craddock

  3. BSBMT Registry, Guy’s Hospital, London, UK

    R Pearce, J Perry & K Kirkland

  4. Nottingham University Hospitals, Nottingham, UK

    J Byrne & N Russell

  5. Royal Marsden NHS Foundation Trust, Surrey, Sutton, UK

    F Dignan & B E Shaw

  6. Manchester Royal Infirmary, Manchester, UK

    E Tholouli

  7. Leeds Teaching Hospitals, Leeds, UK

    M Gilleece & G Cook

  8. Oxford University Hospitals NHS Trust, Oxford, UK

    T Littlewood & A Peniket

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  1. E Nikolousis
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  15. G Cook
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Correspondence to C Craddock.

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Nikolousis, E., Nagra, S., Pearce, R. et al. Impact of pre-transplant co-morbidities on outcome after alemtuzumab-based reduced intensity conditioning allo-SCT in elderly patients: A British Society of Blood and Marrow Transplantation study. Bone Marrow Transplant 50, 82–86 (2015). https://doi.org/10.1038/bmt.2014.215

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  • DOI: https://doi.org/10.1038/bmt.2014.215

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