Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Transplant Toxicities

Influence of age on outcome after allogeneic hematopoietic cell transplantation: a single center study in patients aged 60

Abstract

Reduced intensity conditioning regimens lead to an increasing use of allogeneic hematopoietic cell transplantation (HCT) in elderly patients. We retrospectively analyzed 151 patients aged 60 receiving allogeneic HCT 2000–2012 at our center. Median age was 66 years. Kaplan–Meier estimated 3-year OS was 42% with a median follow-up of 38 months. Cumulative incidences of progression and non-relapse mortality after 3 years were 38 and 24%. OS was better in the group of patients >65 years with a Kaplan–Meier estimated OS of 50% vs 34%, P=0.060. We observed a significant influence of donor age (<50 years: 53% vs >50 years: 30%, P=0.017) and gender match (matched: 57% vs mismatched: 32%, P=0.007) on outcome. The use of a matched related donor was inferior compared with a matched or mismatched unrelated donor (19% vs 47%, P=0.015). On multivariate analysis there was an increased hazard ratio for a non-gender-matched HLA-matched-related donor (hazard ratio 3.23, 95% confidence interval 1.55–6.74, P=0.002). Age had no significant impact on OS (P=0.414). In conclusion, the data suggest that older age alone has no negative impact on the outcome of allogeneic HCT. Transplant decision should be tailored to disease risk and patient performance status rather than age.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Xie Y, Davies SM, Xiang Y, Robison LL, Ross JA . Trends in leukemia incidence and survival in the United States (1973–1998). Cancer 2003; 97: 2229–2235.

    Article  PubMed  Google Scholar 

  2. Siegel R, Naishadham D, Jemal A . Cancer statistics, 2012. CA Cancer J Clin 2012; 62: 10–29.

    Article  PubMed  Google Scholar 

  3. Buchner T, Berdel WE, Haferlach C, Haferlach T, Schnittger S, Muller-Tidow C et al. Age-related risk profile and chemotherapy dose response in acute myeloid leukemia: a study by the German Acute Myeloid Leukemia Cooperative Group. J Clin Oncol 2009; 27: 61–69.

    Article  PubMed  Google Scholar 

  4. Hasenclever D, Diehl V . A prognostic score for advanced Hodgkin's disease. International Prognostic Factors Project on Advanced Hodgkin's Disease. N Engl J Med 1998; 339: 1506–1514.

    Article  CAS  PubMed  Google Scholar 

  5. Solal-Celigny P, Roy P, Colombat P, White J, Armitage JO, Arranz-Saez R et al. Follicular lymphoma international prognostic index. Blood 2004; 104: 1258–1265.

    Article  CAS  PubMed  Google Scholar 

  6. Evens AM, Sweetenham JW, Horning SJ . Hodgkin lymphoma in older patients: an uncommon disease in need of study. Oncology (Williston Park) 2008; 22: 1369–1379.

    Google Scholar 

  7. Rowe JM . Optimal management of adults with ALL. Br J Haematol 2009; 144: 468–483.

    Article  PubMed  Google Scholar 

  8. Appelbaum FR, Gundacker H, Head DR, Slovak ML, Willman CL, Godwin JE et al. Age and acute myeloid leukemia. Blood 2006; 107: 3481–3485.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Slavin S, Nagler A, Naparstek E, Kapelushnik Y, Aker M, Cividalli G et al. Nonmyeloablative stem cell transplantation and cell therapy as an alternative to conventional bone marrow transplantation with lethal cytoreduction for the treatment of malignant and nonmalignant hematologic diseases. Blood 1998; 91: 756–763.

    CAS  PubMed  Google Scholar 

  10. Sorror ML, Sandmaier BM, Storer BE, Franke GN, Laport GG, Chauncey TR et al. Long-term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies. JAMA 2011; 306: 1874–1883.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Armand P, Gibson CJ, Cutler C, Ho VT, Koreth J, Alyea EP et al. A disease risk index for patients undergoing allogeneic stem cell transplantation. Blood 2012; 120: 905–913.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Brunner AM, Kim HT, Coughlin E, Alyea EP 3rd, Armand P, Ballen KK et al. Outcomes in patients age 70 or older undergoing allogeneic hematopoietic stem cell transplantation for hematologic malignancies. Biol Blood Marrow Transplant 2013; 19: 1374–1380.

    Article  PubMed  Google Scholar 

  14. Glucksberg H, Storb R, Fefer A, Buckner CD, Neiman PE, Clift RA et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation 1974; 18: 295–304.

    Article  CAS  PubMed  Google Scholar 

  15. Lee SJ, Vogelsang G, Flowers ME . Chronic graft-versus-host disease. Biol Blood Marrow Transplant 2003; 9: 215–233.

    Article  CAS  PubMed  Google Scholar 

  16. Bacigalupo A, Ballen K, Rizzo D, Giralt S, Lazarus H, Ho V et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant 2009; 15: 1628–1633.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Giralt S, Ballen K, Rizzo D, Bacigalupo A, Horowitz M, Pasquini M et al. Reduced-intensity conditioning regimen workshop: defining the dose spectrum. Report of a workshop convened by the center for international blood and marrow transplant research. Biol Blood Marrow Transplant 2009; 15: 367–369.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bader P, Beck J, Frey A, Schlegel PG, Hebarth H, Handgretinger R et al. Serial and quantitative analysis of mixed hematopoietic chimerism by PCR in patients with acute leukemias allows the prediction of relapse after allogeneic BMT. Bone Marrow Transplant 1998; 21: 487–495.

    Article  CAS  PubMed  Google Scholar 

  19. Pepe MS, Mori M . Kaplan-Meier, marginal or conditional probability curves in summarizing competing risks failure time data? Stat Med 1993; 12: 737–751.

    Article  CAS  PubMed  Google Scholar 

  20. Koreth J, Aldridge J, Kim HT, Alyea EP III, Cutler C, Armand P et al. Reduced-intensity conditioning hematopoietic stem cell transplantation in patients over 60 years: hematologic malignancy outcomes are not impaired in advanced age. Biol Blood Marrow Transplant 2010; 16: 792–800.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lim Z, Brand R, Martino R, van Biezen A, Finke J, Bacigalupo A et al. Allogeneic hematopoietic stem-cell transplantation for patients 50 years or older with myelodysplastic syndromes or secondary acute myeloid leukemia. J Clin Oncol 2010; 28: 405–411.

    Article  PubMed  Google Scholar 

  22. McClune BL, Weisdorf DJ, Pedersen TL, Tunes da Silva G, Tallman MS, Sierra J et al. Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome. J Clin Oncol 2010; 28: 1878–1887.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lim ZY, Ingram W, Brand R, Ho A, Kenyon M, Devereux S et al. Impact of pretransplant comorbidities on alemtuzumab-based reduced-intensity conditioning allogeneic hematopoietic SCT for patients with high-risk myelodysplastic syndrome and AML. Bone Marrow Transplant 2010; 45: 633–639.

    Article  CAS  PubMed  Google Scholar 

  24. Boehm A, Sperr WR, Leitner G, Worel N, Oehler L, Jaeger E et al. Comorbidity predicts survival in myelodysplastic syndromes or secondary acute myeloid leukaemia after allogeneic stem cell transplantation. Eur J Clin Invest 2008; 38: 945–952.

    Article  CAS  PubMed  Google Scholar 

  25. Hegenbart U, Niederwieser D, Sandmaier BM, Maris MB, Shizuru JA, Greinix H et al. Treatment for acute myelogenous leukemia by low-dose, total-body, irradiation-based conditioning and hematopoietic cell transplantation from related and unrelated donors. J Clin Oncol 2006; 24: 444–453.

    Article  CAS  PubMed  Google Scholar 

  26. Kroger N, Zabelina T, de Wreede L, Berger J, Alchalby H, van Biezen A et al. Allogeneic stem cell transplantation for older advanced MDS patients: improved survival with young unrelated donor in comparison with HLA-identical siblings. Leukemia 2013; 27: 604–609.

    Article  CAS  PubMed  Google Scholar 

  27. Ringden O, Horowitz MM, Gale RP, Biggs JC, Gajewski J, Rimm AA et al. Outcome after allogeneic bone marrow transplant for leukemia in older adults. JAMA 1993; 270: 57–60.

    Article  CAS  PubMed  Google Scholar 

  28. Nakai K, Kanda Y, Fukuhara S, Sakamaki H, Okamoto S, Kodera Y et al. Value of chemotherapy before allogeneic hematopoietic stem cell transplantation from an HLA-identical sibling donor for myelodysplastic syndrome. Leukemia 2005; 19: 396–401.

    Article  CAS  PubMed  Google Scholar 

  29. de Witte T, Hermans J, Vossen J, Bacigalupo A, Meloni G, Jacobsen N et al. Haematopoietic stem cell transplantation for patients with myelo-dysplastic syndromes and secondary acute myeloid leukaemias: a report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT). Br J Haematol 2000; 110: 620–630.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We would like to thank the study nurses and staff of the transplant unit, who took part in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to W A Bethge.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Federmann, B., Faul, C., Meisner, C. et al. Influence of age on outcome after allogeneic hematopoietic cell transplantation: a single center study in patients aged 60. Bone Marrow Transplant 50, 427–431 (2015). https://doi.org/10.1038/bmt.2014.292

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2014.292

This article is cited by

Search

Quick links