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Biol Blood Marrow Transplant. 2019 Mar;25(3):488-495. doi: 10.1016/j.bbmt.2018.08.029. Epub 2018 Sep 5.

Allogeneic Hematopoietic Cell Transplantation in Patients Aged 50Years or Older with Severe Aplastic Anemia.

Author information

1
Department of Haematology, King's College Hospital, London, United Kingdom.
2
EBMT Statistical Unit, Leiden, Netherlands.
3
Department of Haematology, King's College Hospital, London, United Kingdom; Department of Haematology, King's College London, London, United Kingdom. Electronic address: Judith.marsh@nhs.net.
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
Department of Haematology, King's College Hospital, London, United Kingdom; Department of Haematology, King's College London, London, United Kingdom.
22
Hopital St. Louis, Paris, France.
23
Instituto Giannina Gaslini, Genova, Italy.

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.

KEYWORDS:

Aplastic anemia; Hematopoietic cell transplant; Survival

PMID:
30194027
PMCID:
PMC6401340
[Available on 2020-03-01]
DOI:
10.1016/j.bbmt.2018.08.029

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