TY - JOUR
T1 - Allogeneic Hematopoietic Cell Transplantation in Patients Aged 50Years or Older with Severe Aplastic Anemia
AU - Rice, Carmel
AU - Eikema, Dirk Jan
AU - Marsh, Judith C.W.
AU - Knol, Cora
AU - Hebert, Kyle
AU - Putter, Hein
AU - Peterson, Eefke
AU - Deeg, H. Joachim
AU - Halkes, Stijn
AU - Pidala, Joseph
AU - Anderlini, Paolo
AU - Tischer, Johanna
AU - Kroger, Nicolaus
AU - McDonald, Andrew
AU - Antin, Joseph H.
AU - Schaap, Nicolaas P.
AU - Hallek, Michael
AU - Einsele, Herman
AU - Mathews, Vikram
AU - Kapoor, Neena
AU - Boelens, Jaap Jan
AU - Mufti, Ghulam J.
AU - Potter, Victoria
AU - Pefault de la Tour, Régis
AU - Eapen, Mary
AU - Dufour, Carlo
N1 - Funding Information:
Financial disclosure: The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases (NIAID); grant 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration; and grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration, or any other agency of the US Government.
Funding Information:
Financial disclosure: The CIBMTR is supported primarily by Public Health Service Grant/Cooperative Agreement 5U24-CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI), and the National Institute of Allergy and Infectious Diseases (NIAID); grant 5U10HL069294 from NHLBI and NCI; a contract HHSH250201200016C with Health Resources and Services Administration; and grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, Health Resources and Services Administration, or any other agency of the US Government. Conflict of interest statement: There are no conflicts of interest to report. Authorship statement: C.R. D.J.E. J.C.W.M. K.H. V.P. and M.E. designed the study. D.J.E. C.K. and K.H. prepared the study file and analyzed and interpreted results. C.R. and V.P. drafted the manuscript. J.C.W.M. and M.E. critically reviewed and edited the manuscript. D.J.E. K.H. H.P. E.P. H.J.D. C.J.M.H. J.P. P.A. J.T. N.K. A.M.D. J.H.A. N.S. M.H. H.E. V.M. N.K. J.J.B. G.J.M. R.T.P. and C.D. reviewed and approved the final manuscript. Financial disclosure: See Acknowledgments on page 494.
Publisher Copyright:
© 2018 American Society for Blood and Marrow Transplantation
PY - 2019/3
Y1 - 2019/3
N2 - 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.
AB - 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.
KW - Aplastic anemia
KW - Hematopoietic cell transplant
KW - Survival
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U2 - 10.1016/j.bbmt.2018.08.029
DO - 10.1016/j.bbmt.2018.08.029
M3 - Article
C2 - 30194027
AN - SCOPUS:85054749211
SN - 1083-8791
VL - 25
SP - 488
EP - 495
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 3
ER -