TY - JOUR
T1 - Allogeneic Hematopoietic Cell Transplantation for Older Patients
T2 - Prognosis Determined by Disease Risk Index
AU - He, Fiona
AU - Cao, Qing
AU - Lazaryan, Aleksandr
AU - Brunstein, Claudio
AU - Holtan, Shernan
AU - Warlick, Erica
AU - Ustun, Celalettin
AU - McClune, Brian
AU - Arora, Mukta
AU - Rashidi, Armin
AU - Eckfeldt, Craig
AU - Weisdorf, Daniel J.
AU - Bejanyan, Nelli
N1 - Publisher Copyright:
© 2017 The American Society for Blood and Marrow Transplantation
PY - 2017/9
Y1 - 2017/9
N2 - The treatment of elderly patients with advanced hematological malignancies has expanded to include reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (alloHCT) as a potentially curative option. We studied the association between Disease Risk Index (DRI) and clinical outcomes of 196 elderly patients (median age, 64.8; range, 60 to 75 years) with hematological malignancies receiving RIC alloHCT (2000 to 2014). Donors were related and unrelated adults (n = 100, 51.1%) or umbilical cord blood (n = 96, 48.9%). DRI classified 12 patients (6.1%) as low risk (LR), 146 patients (74.5%) as intermediate risk (IR), and 38 patients (19.4%) as high risk (HR). Two-year overall survival (OS) was 47% (52% for LR/IR versus 29% for HR, P <.01) and 2-year disease-free survival was 39% (44% for LR/IR versus 21% for HR, P <.01). Relapse incidence was 30% (26% for LR/IR versus 44% for HR, P <.01). Treatment-related mortality was 29% at 2 years; this was similar for all DRI groups. In multiple regression analysis, HR DRI was associated with increased risk of relapse (hazard ratio, 2.07; 95% confidence interval [CI], 1.34 to 3.33; P =.02) and treatment failure (hazard ratio, 2.07; 95% CI, 1.35 to 3.18; P <.01) and decreased OS (hazard ratio, 2.11; 95% CI, 1.34 to 3.33; P <.01). In elderly patients, DRI is a significant prognostic factor for post-transplantation relapse, treatment failure, and mortality. Because of increased risk of relapse leading to poor survival in HR DRI, participation in clinical trials offering relapse prevention strategies after RIC alloHCT should be encouraged when available.
AB - The treatment of elderly patients with advanced hematological malignancies has expanded to include reduced-intensity conditioning (RIC) allogeneic hematopoietic cell transplantation (alloHCT) as a potentially curative option. We studied the association between Disease Risk Index (DRI) and clinical outcomes of 196 elderly patients (median age, 64.8; range, 60 to 75 years) with hematological malignancies receiving RIC alloHCT (2000 to 2014). Donors were related and unrelated adults (n = 100, 51.1%) or umbilical cord blood (n = 96, 48.9%). DRI classified 12 patients (6.1%) as low risk (LR), 146 patients (74.5%) as intermediate risk (IR), and 38 patients (19.4%) as high risk (HR). Two-year overall survival (OS) was 47% (52% for LR/IR versus 29% for HR, P <.01) and 2-year disease-free survival was 39% (44% for LR/IR versus 21% for HR, P <.01). Relapse incidence was 30% (26% for LR/IR versus 44% for HR, P <.01). Treatment-related mortality was 29% at 2 years; this was similar for all DRI groups. In multiple regression analysis, HR DRI was associated with increased risk of relapse (hazard ratio, 2.07; 95% confidence interval [CI], 1.34 to 3.33; P =.02) and treatment failure (hazard ratio, 2.07; 95% CI, 1.35 to 3.18; P <.01) and decreased OS (hazard ratio, 2.11; 95% CI, 1.34 to 3.33; P <.01). In elderly patients, DRI is a significant prognostic factor for post-transplantation relapse, treatment failure, and mortality. Because of increased risk of relapse leading to poor survival in HR DRI, participation in clinical trials offering relapse prevention strategies after RIC alloHCT should be encouraged when available.
KW - Disease Risk Index
KW - Elderly
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UR - http://www.scopus.com/inward/citedby.url?scp=85021147380&partnerID=8YFLogxK
U2 - 10.1016/j.bbmt.2017.05.012
DO - 10.1016/j.bbmt.2017.05.012
M3 - Article
C2 - 28522345
AN - SCOPUS:85021147380
SN - 1083-8791
VL - 23
SP - 1485
EP - 1490
JO - Biology of Blood and Marrow Transplantation
JF - Biology of Blood and Marrow Transplantation
IS - 9
ER -