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Allografting for Older Patients

Allogeneic myeloablative transplantation for patients aged 50 years and over

Bone Marrow Transplantation volume 34, pages 29–35 (2004)Cite this article

Summary:

Allogeneic hematopoietic stem cell transplantation (HSCT) has been performed mainly for young patients due to concern about the high incidence of treatment-related mortality (TRM). Recent advances to reduce TRM by using peripheral blood stem cells or nonmyeloablative conditioning regimens have increased the age limit for this procedure, and correctly identifying the indication for transplant is essential for older patients. In this study, we analyzed data from 398 patients aged 50 or over selected from 5147 patients, who received conventional allogeneic HSCT (c-HSCT). Patients aged 50 or older showed inferior outcomes for TRM and overall survival (OS). Mulitivariate analyses confirmed that an age of 50 or over was an independent risk factor for TRM (P<0.0001) and OS (P<0.0001). Among patients aged 50 or older, increasing age remained an adverse factor for OS (P=0.0213). Regimens including total-body irradiation (TBI) correlated with a higher risk of TRM and a lower OS for older patients (P=0.0095 and 0.0303, respectively). These findings indicate that allogeneic c-HSCT should be offered to patients over 50 years only if the increased risk of TRM is acceptable, and that a non-TBI regimen is preferable when the transplant is performed.

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Acknowledgements

This study was conducted as Working Group 8 of the JSHCT. We are indebted to Ritsuro Suzuki of Aichi Cancer Center for his critical comments. We also thank all physicians and staff at the cooperating centers for contributing patient data for this study.

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Authors and Affiliations

  1. Department of Hematology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    M Yanada, N Emi & T Naoe

  2. Hematology Division, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

    H Sakamaki

  3. Department of Hematology and Oncology, Institute of Medical Science, University of Tokyo, Tokyo, Japan

    T Iseki & S Takahashi

  4. Department of Hematology, Nagoya Daini Red Cross Hospital, Nagoya, Japan

    N Hirabayashi

  5. Fifth Department of Internal Medicine, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan

    T Karasuno

  6. Department of Cell Therapy and Transplantation Medicine, University of Tokyo Hospital, Tokyo, Japan

    S Chiba

  7. Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Y Atsuta & N Hamajima

  8. Department of Cell Transplantation and Regeneration Medicine, Institute of Medical Science, Tokai University School of Medicine, Isehara, Japan

    S Kato

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  1. M Yanada
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  2. N Emi
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  3. T Naoe
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  10. N Hamajima
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  11. S Takahashi
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  12. S Kato
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Correspondence to M Yanada.

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Yanada, M., Emi, N., Naoe, T. et al. Allogeneic myeloablative transplantation for patients aged 50 years and over. Bone Marrow Transplant 34, 29–35 (2004). https://doi.org/10.1038/sj.bmt.1704518

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  • DOI: https://doi.org/10.1038/sj.bmt.1704518

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