In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥ 70 years with hematologic malignancies across the United States. Adults ≥ 70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥ 70 years underwent HCT across 103 transplant centers. The number and proportion of allografts performed in this population rose markedly over the past decade, accounting for 0.1% of transplants in 2000 to 3.85% (N = 298) in 2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications. Two-year OS and PFS significantly improved over time (OS: 26% [95% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥ 3 (hazard ratio [HR], 1.27; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥ 70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.
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The CIBMTR is supported primarily by National Institutes of Health public health service grant/cooperative agreement 5U24-CA076518 from the National Cancer Institute; the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases; grant/cooperative agreement 5U10HL069294 from the National Heart, Lung, and Blood Institute and the National Cancer Institute; contract HHSH250201200016C with Health Resources and Services Administration (US Department of Health and Human Services); grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research. This work was also funded by grants from Actinium Pharmaceuticals, Inc.,* Alexion, and Amgen, Inc.*; by an anonymous donation to the Medical College of Wisconsin; by Astellas Pharma US, AstraZeneca, Atara Biotherapeutics, Inc., Be the Match Foundation, Bluebird Bio, Inc.,* Bristol Myers Squibb Oncology,* Celgene Corporation,* Cellular Dynamics International, Inc., Cerus Corporation, Chimerix, Inc.,* the Fred Hutchinson Cancer Research Center, Gamida Cell Ltd., Genentech, Inc., Genzyme Corporation, Gilead Sciences, Inc., Health Research, Inc., Roswell Park Cancer Institute, HistoGenetics, Inc., Incyte Corporation, Janssen Scientific Affairs, LLC, Jazz Pharmaceuticals, Inc.,* the Jeff Gordon Children’s Foundation, The Leukemia & Lymphoma Society, Medac, GmbH, MedImmune, The Medical College of Wisconsin, Merck & Co, Inc.,* Mesoblast,* MesoScale Diagnostics, Inc., Miltenyi Biotec, Inc.,* National Marrow Donor Program, Neovii Biotech NA, Inc., Novartis Pharmaceuticals Corporation, Onyx Pharmaceuticals, Optum Healthcare Solutions, Inc., Otsuka America Pharmaceutical, Inc., Otsuka Pharmaceutical Co, Ltd., Japan, PCORI, Perkin Elmer, Inc., Pfizer, Inc., Sanofi US,* Seattle Genetics,* Spectrum Pharmaceuticals, Inc.,* St. Baldrick’s Foundation, Sunesis Pharmaceuticals, Inc.,* Swedish Orphan Biovitrum, Inc., Takeda Oncology, Telomere Diagnostics, Inc., the University of Minnesota, and Wellpoint, Inc.* (asterisk indicates corporate members).
The online version of this article contains a data supplement.
Muffly, Lori; Pasquini, Marcelo C.; Martens, Michael; Brazauskas, Ruta; Zhu, Xiaochun; Adekola, Kehinde; Aljurf, Mahmoud; Ballen, Karen K.; Bajel, Ashish; Baron, Frederic; Battiwalla, Minoo; Beitinjaneh, Amer; Cahn, Jean-Yves; Carabasi, Mathew; Chen, Yi-Bin; Chhabra, Saurabh; Ciurea, Stefan; Copelan, Edward; D'Souza, Anita; Edwards, John; Foran, James; Freytes, Cesar O.; Fung, Henry C.; Gale, Robert Peter; Giralt, Sergio; Hashmi, Shahrukh K.; Hildebrandt, Gerhard C.; Ho, Vincent; Jakubowski, Ann; and Lazarus, Hillard, "Increasing Use of Allogeneic Hematopoietic Cell Transplantation in Patients Aged 70 Years and Older in the United States" (2017). Internal Medicine Faculty Publications. 165.