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Lack of disease control remains a major barrier to transplant for older patients with AML

Bone Marrow Transplantation volume 58, pages 1054–1056 (2023)Cite this article

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Allogeneic hematopoietic stem cell transplantation (alloHCT) is a potentially curative treatment for patients with acute myeloid leukemia (AML) [1]. Historically, the significant toxicity associated with myeloablative (MA) conditioning regimens has largely precluded older adults from being considered for alloHCT [2]. However, advances in donor-selection, reduced-intensity conditioning (RIC) regimens, and supportive measures have proven to be more efficacious and better tolerated [3, 4]. Consequently, both increased utilization of alloHCT and improved outcomes have been observed in older patients with hematologic malignancies over the past few decades [5]. A recent analysis of Center for International Blood and Marrow Transplant Research (CIBMTR) data for 1321 AML patients ≥60 years old undergoing alloHCT between 2007 to 2017 demonstrated that age, compared to other disease-related risk factors, had only a small effect on overall survival (OS) and treatment-related mortality (TRM) [6]. With a growing number of older patients with AML now being referred for alloHCT, a better understanding of the current barriers facing this population are needed.

Here, we present a single-institution, retrospective analysis of the outcomes and experiences of patients ≥65 years old with a diagnosis of AML at the University of California, San Francisco (UCSF) between 1/1/2010–12/31/2019 who were evaluated for alloHCT. Because UCSF AML oncologists manage their own patients’ transplant (i.e., no separate BMT department or referral process), evaluation for transplant in this study was defined as receipt of human leukocyte antigen (HLA)-typing. While most patients at our institution receiving intensive induction (i.e., “7 + 3” or high dose cytarabine-based regimens) will undergo HLA-typing at the time of diagnosis, patients receiving lower intensity induction will only undergo HLA-typing if their oncologist is considering alloHCT. There is no maximal age limitation for transplant consideration at UCSF. Baseline demographic data, disease characteristics/risk, performance status, and comorbidities were tabulated for patients and compared using a T- or Fisher’s exact test. For patients who did not receive alloHCT after HLA-typing, we reviewed oncology and social worker clinic notes to identify documented reasons for not proceeding to transplant. Survival was defined starting from time of AML diagnosis until an analysis cut-off date of 5/2022. Kaplan–Meier curves and survival analyses with log-ranked (Mantel–Cox) tests were performed using GraphPad Prism version 9.4.0. The UCSF IRB approved this study and waived the need for informed consent.

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Fig. 1: Lack of adequate of disease control is predominant cited factor for not proceeding with alloHCT in older patients with AML who underwent HLA-typing.

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors gratefully acknowledge all the patients who contributed material and clinical information to this study. This study was funded through a resident research funding grant from the UCSF Clinical and Translational Science Institute (CTSI).

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Authors and Affiliations

  1. Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA

    Mark Y. Jeng & Rebecca L. Olin

  2. Immunogenetics and Transplantation Laboratory, Department of Surgery, University of California San Francisco, San Francisco, CA, USA

    Denice Kong & Raja Rajalingam

  3. Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Richard J. Lin

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  1. Mark Y. Jeng
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Contributions

RLO and RJL initiated and designed the study; DK and RR extracted the initial patient list; MYJ extracted and compiled patient data, conducted the statistical analysis, and wrote the manuscript; and all authors contributed to the review of the final manuscript.

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Correspondence to Rebecca L. Olin.

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Jeng, M.Y., Kong, D., Rajalingam, R. et al. Lack of disease control remains a major barrier to transplant for older patients with AML. Bone Marrow Transplant 58, 1054–1056 (2023). https://doi.org/10.1038/s41409-023-02022-3

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