Allogeneic Hematopoietic Cell Transplantation Effective For The Elderly (EHA 2009)
At the European Hematology Association 14th Congress, held in Berlin, German researchers showed that older myelodysplastic syndromes (MDS) patients could also be considered as candidates for allogeneic hematopoietic cell transplantation (HCT).
Allogeneic HCT, the replacement of abnormal patient bone marrow with healthy donor stem cells, is the only therapy known to cure MDS. However, the possibility of graft versus host disease, in which donated stem cells react against the patient’s tissue, and other complications, limit the number of MDS patients who undergo HCT. Though studies have shown allogeneic HCT to extend survival time for MDS patients below the age of 60 years, the procedure has been considered too risky for most patients over 60 years due to significant transplant-associated mortality rates of 10 to 30 percent.
This study investigated the advantage of allogeneic HCT for the survival of elderly patients. Eighty-nine patients, ranging from age 60 to 71 and diagnosed with primary MDS unrelated to prior chemotherapy or heavy exposure to chemicals, received chemotherapy and radiation in preparation for the transplant. Thirty patients received standard-intensity treatment while 59 patients received a reduced dose.
Three years after transplantation, 40 percent of patients were still alive, demonstrating the effectiveness of allogeneic HCT for MDS patients older than 60 years. However, the results depended on marrow blast percentages before the transplant; only 29 percent of patients with more than 20 percent blasts survived after three years, compared to 44 percent of patients with less than 20 percent blasts. Furthermore, it was observed that the presence of additional diseases decreased overall survival rates.
The study concluded that time between diagnosis and treatment, the presence of additional diseases, and intensity of chemotherapy and radiation conditioning affected overall survival rates. However, age, donor relation, and presence of chromosomal abnormalities did not affect transplantation success.
Researchers recognized that allogeneic HCT should not be recommended for all elderly patients. Careful selection of patients is important to minimize allogeneic HCT-related mortality. In the future, studies will examine the role of HCT for patients with advanced MDS.
For more information, see abstract 0489 from the “Myelodysplastic syndromes” session of the 14th Congress of the European Hematology Association.
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