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Do adults aged 70 years or older with acute myeloid leukemia benefit from allogeneic hematopoietic cell transplantation?

Leukemia volume 30, pages 1797–1799 (2016)Cite this article

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We read with interest the population-based Dutch study by Dinmohamed et al.1 on patients with acute myeloid leukemia (AML) over a 24-year period (1989–2012). The median age at diagnosis was 66 years, with a sharp increase in age-specific incidence until age 90. Patients ⩾70 years old (denoted AML70) comprised 44% of this cohort, with no changes in treatment patterns over time in this population. This group of patients received supportive care in two-thirds and chemotherapy in one-third of cases. Chemotherapy among patients who received this treatment modality was palliative in 39%. No allogeneic hematopoietic cell transplantation (allo-HCT) was performed in AML70 patients and only 12% of these patients were enrolled in clinical trials. There was no improvement in survival in AML70 patients over the study period, and 5-year relative survival rate was only 2%. Early death (ED; death within 30 days of diagnosis) was 20–25% in AML70 patients. The results of this study support the previous reports showing very poor outcomes of AML70 patients with little improvement in the past three decades.2 Furthermore, they demonstrate poor enrollment in clinical trials and highlight the lack of effective treatments for this age group, despite the fact that the age at diagnosis is ⩾70 years in 40–50% of all AML patients.3

ED rates are significantly lower and overall survival (OS) higher with intensive rather than palliative therapy, even in AML70 patients.3, 4 Similarly, multivariate analysis of AML patients ⩾65 years in the linked surveillance, epidemiology, and end results (SEER)-Medicare database showed improved OS with allo-HCT compared with chemotherapy.4 Also, another analysis of the SEER database between 2000 and 2007 showed superior OS among AML70 patients treated vs those untreated.5 However, there is a paucity of data on allo-HCT outcomes in AML70 patients. Between January 2010 and December 2015, 22 AML70 patients (59% male) underwent an allo-HCT in our institution. The median (range) age of patients and donors was 72 (70–76) and 31 (18–67) years, respectively. AML was therapy-related in one (4%) patient. Concurrent or prior myelodysplasia (MDS) or a myeloproliferative neoplasm was present in 45% of patients. The HCT-comorbidity index was 0–1 in 77% of patients and 73% were in complete remission (CR1: 59%, CR2: 14%) at the time of transplantation. Cytogenetic risk6 was favorable, intermediate, unfavorable and unknown in 0, 64, 32 and 4% of patients, respectively. Transplants were female-to-male and major ABO blood group-mismatched in 23 and 27% of cases, respectively. The donor/recipient cytomegalovirus serostatus was +/+ in 32%, +/− in 9%, −/+ in 36%, −/− in 18% and unknown in one case. 14, 59 and 27% of donors were human leukocyte antigen (HLA)-matched sibling, HLA-matched unrelated donor (MUD) and HLA-haploidentical, respectively. The median (range) for CD34+ and CD3+ cell dose was 5.0 (2.8–9.5) × 106/kg and 13.8 (0.4–73.9) × 107/kg, respectively. Fludarabine-based reduced-intensity conditioning was used in 95% of patients. All transplants were T-replete, and graft-versus-host disease (GvHD) prophylaxis was tacrolimus-based (with post-transplant high-dose cyclophosphamide in haploidentical recipients).

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  1. Division of Oncology, Department of Medicine, Section of Bone Marrow Transplant and Leukemia, Washington University School of Medicine, St Louis, MO, USA

    A Rashidi, J F DiPersio, P Westervelt, R Vij, C N Abboud & R Romee

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Correspondence to R Romee.

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Rashidi, A., DiPersio, J., Westervelt, P. et al. Do adults aged 70 years or older with acute myeloid leukemia benefit from allogeneic hematopoietic cell transplantation?. Leukemia 30, 1797–1799 (2016). https://doi.org/10.1038/leu.2016.99

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