Prognostic factors in patients aged 50 years or older undergoing allogeneic hematopoietic stem cell transplantation for hematologic malignancy View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2012-02-04

AUTHORS

Hirotaka Takasaki, Masatsugu Tanaka, Takayoshi Tachibana, Ayumi Numata, Katsumichi Fujimaki, Rika Sakai, Shin Fujisawa, Naoto Tomita, Hiroyuki Fujita, Atsuo Maruta, Yoshiaki Ishigatsubo, Heiwa Kanamori

ABSTRACT

We retrospectively analyzed patients aged ≥ 50 years with hematologic malignancies who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) to identify preoperative variables predicting the outcome. There were 71 patients with a median age of 57 years (range: 50–63 years) who had acute leukemia (n = 53) or myelodysplastic syndrome (n = 18). Myeloablative conditioning was done in 35 patients and 36 patients had reduced-intensity conditioning. The 5-year overall survival rate (OS), cumulative relapse rate, and non-relapse mortality rate (NRM) were 45, 24, and 33%, respectively. According to multivariate analysis, high-risk disease (HR 3.50, 95% CI 1.43–8.56, P = 0.006), a hematopoietic cell transplantation comorbidity index (HCT-CI) score ≥3 (HR 4.41, 95% CI 1.31–14.77, P = 0.016), and an HLA-mismatched unrelated donor (HR 4.03, 95% CI 1.46–11.10, P = 0.007) were significant predictors of worse OS. High-risk disease was also significantly associated with a higher cumulative relapse rate (HR 4.59, 95% CI 0.94–6.92, P = 0.065). Furthermore, an HCT-CI score ≥3 (HR 3.02, 95% CI 1.01–20.78, P = 0.048) and an HLA-mismatched unrelated donor (HR 3.02, 95% CI 1.04–8.74, P = 0.042) were risk factors for NRM. These results suggest that the disease risk, HCT-CI score, and donor type/histocompatibility are prognostic factors for elderly patients, while the conditioning regimen and age are not predictors. More... »

PAGES

291-298

References to SciGraph publications

  • 2009-02-05. The hematopoietic cell transplantation comorbidity index (HCT-CI) predicts clinical outcomes in lymphoma and myeloma patients after reduced-intensity or non-myeloablative allogeneic stem cell transplantation in LEUKEMIA
  • 2009-04-20. Elevated pretransplant serum ferritin is associated with inferior survival following nonmyeloablative allogeneic transplantation in BONE MARROW TRANSPLANTATION
  • 2005-09-29. Comparative outcome of reduced intensity and myeloablative conditioning regimen in HLA identical sibling allogeneic haematopoietic stem cell transplantation for patients older than 50 years of age with acute myeloblastic leukaemia: a retrospective survey from the Acute Leukemia Working Party (ALWP) of the European group for Blood and Marrow Transplantation (EBMT) in LEUKEMIA
  • 2010-06-14. Prognostic factors in allo-SCT of elderly patients with AML in BONE MARROW TRANSPLANTATION
  • 2004-05-24. Allogeneic myeloablative transplantation for patients aged 50 years and over in BONE MARROW TRANSPLANTATION
  • 2011-07-11. Role of HCT-comorbidity index, age and disease status at transplantation in predicting survival and non-relapse mortality in patients with myelodysplasia and leukemia undergoing reduced-intensity-conditioning hemopoeitic progenitor cell transplantation in BONE MARROW TRANSPLANTATION
  • 2009-08-17. Differential prognostic impact of pretransplant comorbidity on transplant outcomes by disease status and time from transplant: a single Japanese transplant centre study in BONE MARROW TRANSPLANTATION
  • 2010-10-04. Retrospective analysis of common scoring systems and outcome in patients older than 60 years treated with reduced-intensity conditioning regimen and alloSCT in BONE MARROW TRANSPLANTATION
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s12185-012-1009-x

    DOI

    http://dx.doi.org/10.1007/s12185-012-1009-x

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1021636750

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/22302471


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    30 schema:description We retrospectively analyzed patients aged ≥ 50 years with hematologic malignancies who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) to identify preoperative variables predicting the outcome. There were 71 patients with a median age of 57 years (range: 50–63 years) who had acute leukemia (n = 53) or myelodysplastic syndrome (n = 18). Myeloablative conditioning was done in 35 patients and 36 patients had reduced-intensity conditioning. The 5-year overall survival rate (OS), cumulative relapse rate, and non-relapse mortality rate (NRM) were 45, 24, and 33%, respectively. According to multivariate analysis, high-risk disease (HR 3.50, 95% CI 1.43–8.56, P = 0.006), a hematopoietic cell transplantation comorbidity index (HCT-CI) score ≥3 (HR 4.41, 95% CI 1.31–14.77, P = 0.016), and an HLA-mismatched unrelated donor (HR 4.03, 95% CI 1.46–11.10, P = 0.007) were significant predictors of worse OS. High-risk disease was also significantly associated with a higher cumulative relapse rate (HR 4.59, 95% CI 0.94–6.92, P = 0.065). Furthermore, an HCT-CI score ≥3 (HR 3.02, 95% CI 1.01–20.78, P = 0.048) and an HLA-mismatched unrelated donor (HR 3.02, 95% CI 1.04–8.74, P = 0.042) were risk factors for NRM. These results suggest that the disease risk, HCT-CI score, and donor type/histocompatibility are prognostic factors for elderly patients, while the conditioning regimen and age are not predictors.
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