Allogeneic Hematopoietic Cell Transplantation in Patients Aged 50Years or Older with Severe Aplastic Anemia |
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| Authors: | Carmel Rice Dirk-Jan Eikema Judith CW Marsh Cora Knol Kyle Hebert Hein Putter Eefke Peterson H Joachim Deeg Stijn Halkes Joseph Pidala Paolo Anderlini Johanna Tischer Nicolaus Kroger Andrew McDonald Joseph H Antin Nicolaas P Schaap Michael Hallek Herman Einsele Carlo Dufour |
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| Institution: | 1. Department of Haematology, King''s College Hospital, London, United Kingdom;2. EBMT Statistical Unit, Leiden, Netherlands;3. Department of Haematology, King''s College London, London, United Kingdom;4. EBMT Data Office, Leiden, Netherlands;5. Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin;6. Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands;7. University Medical Center Utrecht, Utrecht, Netherlands;8. Fred Hutchinson Cancer Center, Seattle, Washinton;9. Leiden University Medical Centre, Leiden, Netherlands;10. H. Lee Moffitt Cancer Center, Tampa, Florida;11. MD Anderson Cancer Center, Houston, Texas;12. Klinikum Grosshadern, Munich, Germany;13. University Hospital Eppendorf, Hamburg, Germany;14. Albert Stem Cell Transplantation Centre, Pretoria Gauteng, South Africa;15. Dana Farber Cancer Institute, Boston, Massachusetts;16. Radboud University, Nijmegen Medical Centre, Netherlands;17. University of Cologne, Cologne, Germany;18. Universitätsklinikum Würzburg, Würzburg, Germany;19. Christian Medical College Hospital, Vellore, India;20. Children''s Hospital of Los Angeles, Los Angeles, California;21. University Medical Center Utrecht, Utrecht, Netherlands;22. Hopital St. Louis, Paris, France;23. Instituto Giannina Gaslini, Genova, Italy |
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| Abstract: | We report on 499 patients with severe aplastic anemia aged ≥ 50years who underwent hematopoietic cell transplantation (HCT) from HLA-matched sibling (n?=?275, 55%) or HLA-matched (8/8) unrelated donors (n?=?187, 37%) between 2005 and 2016. The median age at HCT was 57.8 years; 16% of patients were 65 to 77years old. Multivariable analysis confirmed higher mortality risks for patients with performance score less than 90% (hazard ratio HR], 1.41; 95% confidence interval CI], 1.03 to 1.92; P?=?.03) and after unrelated donor transplantation (HR, 1.47; 95% CI, 1 to 2.16; P?=?.05). The 3-year probabilities of survival for patients with performance scores of 90 to 100 and less than 90 after HLA-matched sibling transplant were 66% (range, 57% to 75%) and 57% (range, 47% to 76%), respectively. The corresponding probabilities after HLA-matched unrelated donor transplantation were 57% (range, 48% to 67%) and 48% (range, 36% to 59%). Age at transplantation was not associated with survival, but grades II to IV acute graft-versus-host disease (GVHD) risks were higher for patients aged 65years or older (subdistribution HR sHR], 1.7; 95% confidence interval, 1.07 to 2.72; P?=?.026). Chronic GVHD was lower with the GVHD prophylaxis regimens calcineurin inhibitor (CNI)?+?methotrexate (sHR, .52; 95% CI, .33 to .81; P?=?.004) and CNI alone or with other agents (sHR, .27; 95% CI, .14 to .53; P < .001) compared with CNI?+?mycophenolate. Although donor availability is modifiable only to a limited extent, choice of GVHD prophylaxis and selection of patients with good performance scores are key for improved outcomes. |
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| Keywords: | Aplastic anemia Hematopoietic cell transplant Survival |
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