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.

Qol and Patients' Care

Quality of life and outcomes in patients⩾60 years of age after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 49, pages 1426–1431 (2014)Cite this article

Subjects

Abstract

Hematopoietic cell transplantation (HCT) has become an established standard of care for many older patients with hematologic malignancies. The effect of transplantation on the quality of life (QOL) of older patients, however, has not been well studied. We thus analyzed QOL in patients ⩾60 undergoing an allogeneic HCT compared with patients <60 years. Prospective psychometric instruments were administered to 351 patients who underwent HCT from 2003 to 2010. Psychometric data were assessed longitudinally by validated questionnaires: Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), Coping Inventory and the Profile of Mood State-Short Form. Patients ⩾60 reported better social (P=0.006) and functional well-being (P=0.05) with FACT assessment, and had better total scores, (P=0.043) across all time points. When adjusted for baseline QOL scores as a covariate, social well-being remained significantly better, whereas the other scores became non-significant. With a median follow-up of 49 months, there were no significant differences in OS, relapse-free survival, relapse or chronic GVHD. This study provides further evidence that advanced age should not be a barrier in the decision to pursue allogeneic HCT. Older patients achieved comparable QOL when compared with younger patients.

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

Relevant articles

Open Access articles citing this article.

Access options

Rent or buy this article

Get just this article for as long as you need it

$39.95

Learn more

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

Figure 1
Figure 2

References

  1. 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 

  2. Storb R . Reduced-intensity conditioning transplantation in myeloid malignancies. Curr Opin Oncol 2009; 21: S3–S5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Artz AS . From biology to clinical practice: aging and hematopoietic cell transplantation. Biol Blood Marrow Transplant 2012; 18: S40–S45.

    Article  PubMed  Google Scholar 

  4. Alyea EP, Kim HT, Ho V, Cutler C, DeAngelo DJ, Stone R et al. Impact of conditioning regimen intensity on outcome of allogeneic hematopoietic cell transplantation for advanced acute myelogenous leukemia and myelodysplastic syndrome. Biol Blood Marrow Transplant 2006; 12: 1047–1055.

    Article  PubMed  Google Scholar 

  5. Aoudjhane M, Labopin M, Gorin NC, Shimoni A, Ruutu T, Kolb HJ et al. Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic haematopoietic stem cell transplantation for patients older than 50 years of age with acute myeloblastic leukaemia: a retrospective survey from the Acute Leukemia Working Party (ALWP) of the European group for Blood and Marrow Transplantation (EBMT). Leukemia 2005; 19: 2304–2312.

    Article  CAS  PubMed  Google Scholar 

  6. Gupta V, Kroger N, Aschan J, Xu W, Leber B, Dalley C et al. A retrospective comparison of conventional intensity conditioning and reduced-intensity conditioning for allogeneic hematopoietic cell transplantation in myelofibrosis. Bone Marrow Transplant 2009; 44: 317–320.

    Article  CAS  PubMed  Google Scholar 

  7. Luger SM, Ringden O, Zhang MJ, Perez WS, Bishop MR, Bornhauser M et al. Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDS. Bone Marrow Transplant 2012; 47: 203–211.

    Article  CAS  PubMed  Google Scholar 

  8. Ringden O, Labopin M, Ehninger G, Niederwieser D, Olsson R, Basara N et al. Reduced intensity conditioning compared with myeloablative conditioning using unrelated donor transplants in patients with acute myeloid leukemia. J Clin Oncol 2009; 27: 4570–4577.

    Article  PubMed  Google Scholar 

  9. Shimoni A, Hardan I, Shem-Tov N, Yeshurun M, Yerushalmi R, Avigdor A et al. Allogeneic hematopoietic stem-cell transplantation in AML and MDS using myeloablative versus reduced-intensity conditioning: the role of dose intensity. Leukemia 2006; 20: 322–328.

    Article  CAS  PubMed  Google Scholar 

  10. Gupta V, Panzarella T, Li L, Khan J, Sharma A, Lipton JH et al. A prospective study comparing the outcomes and health-related quality of life in adult patients with myeloid malignancies undergoing allogeneic transplantation using myeloablative or reduced-intensity conditioning. Biol Blood Marrow Transplant 2012; 18: 113–124.

    Article  PubMed  Google Scholar 

  11. Lazaryan A, Hamilton BK, McLellan L, Rybicki L, Foster L, Cooper M et al. Comparison of quality of life outcomes and psychosocial fFunctioning between patients undergoing myeloablative or reduced-intensity allogeneic hematopoietic stem cell transplantation for myeloid mMalignancies. Blood 2011; 118: 385–385.

    Google Scholar 

  12. Wong R, Giralt SA, Martin T, Couriel DR, Anagnostopoulos A, Hosing C et al. Reduced-intensity conditioning for unrelated donor hematopoietic stem cell transplantation as406 treatment for myeloid malignancies in patients older than 55 years. Blood 2003; 102: 3052–3059.

    Article  CAS  PubMed  Google Scholar 

  13. Bertz H, Potthoff K, Finke J . Allogeneic stem-cell transplantation from related and unrelated donors in older patients with myeloid leukemia. J Clin Oncol 2003; 21: 1480–1484.

    PubMed  Google Scholar 

  14. Mohty M, de Lavallade H, Ladaique P, Faucher C, Vey N, Coso D et al. The role of reduced intensity conditioning allogeneic stem cell transplantation in patients with acute myeloid leukemia: a donor vs no donor comparison. Leukemia 2005; 19: 916–920.

    Article  CAS  PubMed  Google Scholar 

  15. Mohty M, de Lavallade H, El-Cheikh J, Ladaique P, Faucher C, Furst S et al. Reduced intensity conditioning allogeneic stem cell transplantation for patients with acute myeloid leukemia: long term results of a 'donor' versus 'no donor' comparison. Leukemia 2009; 23: 194–196.

    Article  CAS  PubMed  Google Scholar 

  16. Estey E, de Lima M, Tibes R, Pierce S, Kantarjian H, Champlin R et al. Prospective feasibility analysis of reduced-intensity conditioning (RIC) regimens for hematopoietic stem cell transplantation (HSCT) in elderly patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). Blood 2007; 109: 1395–1400.

    Article  CAS  PubMed  Google Scholar 

  17. Kroger N . Allogeneic stem cell transplantation for elderly patients with myelodysplastic syndrome. Blood 2012; 119: 5632–5639.

    Article  PubMed  Google Scholar 

  18. 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 

  19. Bolwell BJ . Are predictive factors clinically useful in bone marrow transplantation? Bone Marrow Transplantation 2003; 32: 853–861.

    Article  CAS  PubMed  Google Scholar 

  20. Alatrash G, de Lima M, Hamerschlak N, Pelosini M, Wang X, Xiao L et al. Myeloablative reduced-toxicity i.v. busulfan-fludarabine and allogeneic hematopoietic stem cell transplant for patients with acute myeloid leukemia or myelodysplastic syndrome in the sixth through eighth decades of life. Biol Blood Marrow Transplant 2011; 17: 1490–1496.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. McQuellon RP, Russell GB, Cella DF, Craven BL, Brady M, Bonomi A et al. Quality of life measurement in bone marrow transplantation: development of the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) scale. Bone Marrow Transplant 1997; 19: 357–368.

    Article  CAS  PubMed  Google Scholar 

  22. Carver CS . You want to measure coping but your protocol's too long: consider the brief COPE. Internatl J Behav Med 1997; 4: 92–100.

    Article  CAS  Google Scholar 

  23. Baker F, Denniston M, Zabora J, Polland A, Dudley WN . A POMS short form for cancer patients: psychometric and structural evaluation. Psycho-oncology 2002; 11: 273–281.

    Article  PubMed  Google Scholar 

  24. 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 

  25. 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 

  26. Bolwell B, Sobecks R, Pohlman B, Andresen S, Rybicki L, Kuczkowski E et al. A prospective randomized trial comparing cyclosporine and short course methotrexate with cyclosporine and mycophenolate mofetil for GVHD prophylaxis in myeloablative allogeneic bone marrow transplantation. Bone Marrow Transplant 2004; 34: 621–625.

    Article  CAS  PubMed  Google Scholar 

  27. Baker F, Denniston M, Smith T, West MM . Adult cancer survivors: how are they faring? Cancer 2005; 104: 2565–2576.

    Article  PubMed  Google Scholar 

  28. Chevallier P, Szydlo RM, Blaise D, Tabrizi R, Michallet M, Uzunov M et al. Reduced-intensity conditioning before allogeneic hematopoietic stem cell transplantation in patients over 60 years: a report from the SFGM-TC. Biol Blood Marrow Transplant 2012; 18: 289–294.

    Article  PubMed  Google Scholar 

  29. Koreth J, Aldridge J, Kim HT, Alyea EP 3rd, 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 

  30. Wong FL, Francisco L, Togawa K, Bosworth A, Gonzales M, Hanby C et al. Long-term recovery after hematopoietic cell transplantation: predictors of quality-of-life concerns. Blood 2010; 115: 2508–2519.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Lee SJ, Kim HT, Ho VT, Cutler C, Alyea EP, Soiffer RJ et al. Quality of life associated with acute and chronic graft-versus-host disease. Bone Marrow Transplant 2006; 38: 305–310.

    Article  CAS  PubMed  Google Scholar 

  32. Williams LA, Giralt SA, Wang XS, Mobley GM, Mendoza TR, Cohen MZ et al. Measuring the symptom burden of allogeneic hematopoietic stem cell transplantation in patients with and without acute graft-versus-host disease. Biol Blood Marrow Transplant 2009; 15: 20–21.

    Article  Google Scholar 

  33. Blaise D, Tabrizi R, Boher JM, Le Corroller-Soriano AG, Bay JO, Fegueux N et al. Randomized study of 2 reduced-intensity conditioning strategies for human leukocyte antigen-matched, related allogeneic peripheral blood stem cell transplantation: prospective clinical and socioeconomic evaluation. Cancer 2013; 119: 602–611.

    Article  CAS  PubMed  Google Scholar 

  34. Lee SJ, Fairclough D, Parsons SK, Soiffer RJ, Fisher DC, Schlossman RL et al. Recovery after stem-cell transplantation for hematologic diseases. J Clin Oncol 2001; 19: 242–252.

    Article  CAS  PubMed  Google Scholar 

  35. Pidala J, Anasetti C, Jim H . Quality of life after allogeneic hematopoietic cell transplantation. Blood 2009; 114: 7–19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Altmaier EM, Ewell M, McQuellon R, Geller N, Carter SL, Henslee-Downey J et al. The effect of unrelated donor marrow transplantation on health-related quality of life: a report of the unrelated donor marrow transplantation trial (T-cell depletion trial). Biol Blood Marrow Transplant 2006; 12: 648–655.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We thank the transplantation team at the Cleveland Clinic Taussig Cancer Institute for their contributions, and all our patients for their participation. We thank Navneet Majhail MD, MS for his constructive review of the manuscript.

Author information

Authors and Affiliations

  1. Department of Hematologic Oncology and Blood Disorders, Blood and Marrow Transplant Program, Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA,

    B K Hamilton, J Dabney, L McLellan, D Abounader, M Kalaycio, R Sobecks, R Dean, H Duong, B T Hill & B J Bolwell

  2. Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA,

    L Rybicki

  3. Hematology/Oncology, Staten Island University Hospital, New York, NY, USA,

    H Haddad

  4. School of Social Work, Cleveland State University, Cleveland, OH, USA

    L Foster

  5. Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA,

    E A Copelan

Authors
  1. B K Hamilton
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L Rybicki
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Dabney
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L McLellan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. H Haddad
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L Foster
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. D Abounader
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M Kalaycio
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. R Sobecks
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. R Dean
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. H Duong
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. B T Hill
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. B J Bolwell
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. E A Copelan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B K Hamilton.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Supplementary Information accompanies this paper on Bone Marrow Transplantation website

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hamilton, B., Rybicki, L., Dabney, J. et al. Quality of life and outcomes in patients⩾60 years of age after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 49, 1426–1431 (2014). https://doi.org/10.1038/bmt.2014.166

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2014.166

This article is cited by

Search

Advanced search

Quick links