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Biol Blood Marrow Transplant. 2019 Jun 7. pii: S1083-8791(19)30362-3. doi: 10.1016/j.bbmt.2019.05.037. [Epub ahead of print]

OUTCOME OF ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN PATIENTS OVER 69 YEARS OF AGE WITH ACUTE MYELOID LEUKEMIA: ON BEHALF OF THE ACUTE LEUKEMIA WORKING PARTY OF THE EBMT.

Author information

1
CLINTEC, Translational Cell Therapy Research, Karolinska Institutet, Stockholm, Sweden. Electronic address: olle.ringden@ki.se.
2
Department of Haematology, Hôpital Saint Antoine, Paris, France; EBMT Paris study office/CEREST-TC, Paris, France.
3
Chaim Sheba Medical Center, Tel-Hashomer, Israel.
4
Department of Bone Marrow Transplantation, Essen University Hospital, Essen, Germany.
5
Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany.
6
Division of Haematology and Oncology, Leipzig University Hospital, Leipzig, Germany.
7
Deparment of Medicine‒Hematology, Oncology, University of Freiburg, Freiburg, Germany.
8
Department of Hematology/Oncology, University of Muenster, Muenster, Germany.
9
Charité Universitaetsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Hämatologie/Onkologie, Berlin, Germany.
10
Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
11
Bone Marrow Transplantation Centre, Eppendorf University Hospital, Hamburg, Germany.
12
Universitaet Tuebingen, Medizinische Klinik, Tuebingen, Germany.
13
Deutsche Klinik fuer Diagnostik, KMT Zentrum, Wiesbaden, Germany.
14
Division of Hematology/Oncology, Medical Center, Nashville, TN, USA.
15
CLINTEC, Translational Cell Therapy Research, Karolinska Institutet, Stockholm, Sweden.
16
EBMT Paris study office/CEREST-TC, Paris, France; Chaim Sheba Medical Center, Tel-Hashomer, Israel.

Abstract

Reduced intensity conditioning (RIC) enables allogeneic hematopoietic stem cell transplantation (HSCT) in older patients with acute myeloid leukemia (AML). Between 2004 and 2014, 713 patients ≥70 years of age and 16,161 aged between 50 and 69 years underwent HSCT and these groups were compared. A higher proportion of the older patients were male and had secondary AML, active disease, peripheral blood stem cell grafts, matched unrelated donors, RIC, and a poorer Karnofsky score (p<0.001). In multivariate analysis, the incidences of acute and chronic GVHD and relapse were the same. Non-relapse mortality (NRM) at two years was 34% [95% confidence interval (CI) 31-38%] in patients ≥70 years and 24% (25-32%) in those who were 50-69 years of age (p<0.001). Survival at 2 years was 38% (34-42%) and 50% (49-50%), respectively, in the two groups (p<0.001). In patients with active disease, the corresponding figures were 35% (29-41%) in those ≥ 70 and 33% (31-34%) in those under 70 years of age (p=0.36). In patients ≥ 70 years of age, a Karnofsky score of ≥ 80% was associated with improved survival (HR 1.53, CI 1.14-2.06; p=0.003). To conclude, patients ≥ 70 years of age had worse outcome except for those with active AML.

KEYWORDS:

Acute myeloid leukemia; Allogeneic hematopoietic stem cell transplantation; Elderly; Graft-versus-host disease; Leukemia-free survival

PMID:
31181255
DOI:
10.1016/j.bbmt.2019.05.037

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