1
|
Lin RJ, Dahi PB, Korc-Grodzicki B, Shahrokni A, Jakubowski AA, Giralt SA. Transplantation and Cellular Therapy for Older Adults-The MSK Approach. Curr Hematol Malig Rep 2024; 19:82-91. [PMID: 38332462 PMCID: PMC11126330 DOI: 10.1007/s11899-024-00725-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE OF REVIEW Hematologic malignances more commonly affect older individuals and often present with advanced, higher risk disease than younger patients. Allogeneic and autologous hematopoietic cell transplantation is well-established treatment modalities with curative potential following either frontline treatments for these diseases or salvage therapy in the relapsed or refractory setting. More recently, novel cellular immunotherapy such as chimeric antigen receptor T-cell therapy has been shown to lead to high response rate and durable remission in many patients with advanced blood cancers. RECENT FINDINGS Given unique characteristics of older patients, how best to deliver these higher-intensity and time sensitive treatment modalities for them remains challenging. Moreover, their short-term and potential long-term impact on their functional status, cognitive status, and quality of life may be significant considerations for many older patients. All these issues contributed to the lack of access and significant underutilization of these potential curative treatment strategies. In this review, we present up to date evidence to support potential benefits of transplantation and cellular therapy for older adults, their steady improving outcomes, and most importantly, highlight the use of geriatric assessment to help select appropriate older patients and optimize them prior to and following transplantation and cellular therapy. We specifically describe our approach at Memorial Sloan Kettering Cancer Center and encouraging early results from its implementation.
Collapse
Affiliation(s)
- Richard J Lin
- Adult Blood and Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- David H. Koch Center for Cancer Care, Memorial Sloan Kettering Cancer Center, 530 E 74th Street, Room 21-142, New York, NY, 10022, USA.
| | - Parastoo B Dahi
- Adult Blood and Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Beatriz Korc-Grodzicki
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Armin Shahrokni
- Geriatrics Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Ann A Jakubowski
- Adult Blood and Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Sergio A Giralt
- Adult Blood and Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| |
Collapse
|
2
|
Spyridonidis A, Labopin M, Gedde-Dahl T, Ganser A, Stelljes M, Craddock C, Wagner-Drouet EM, Versluis J, Schroeder T, Blau IW, Wulf GG, Dreger P, Olesen G, Sengeloev H, Kröger N, Potter V, Forcade E, Passweg J, de Latour RP, Maertens J, Wilson KMO, Bourhis JH, Finke J, Brissot E, Bazarbachi A, Giebel S, Savani BP, Nagler A, Ciceri F, Mohty M. Validation of the transplant conditioning intensity (TCI) index for allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 2024; 59:217-223. [PMID: 37978322 PMCID: PMC10849946 DOI: 10.1038/s41409-023-02139-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 10/05/2023] [Accepted: 10/18/2023] [Indexed: 11/19/2023]
Abstract
The intensity of the conditioning regimen given before allogeneic hematopoietic cell transplantation (allo-HCT) can vary substantially. To confirm the ability of the recently developed transplant conditioning intensity (TCI) score to stratify the preparative regimens of allo-HCT, we used an independent and contemporary patient cohort of 4060 transplant recipients with acute myeloid leukemia meeting inclusion criteria from the discovery study (allo-HCT in first complete remission, matched donor), but who were allografted in a more recent period (2018-2021) and were one decade older (55-75 years, median 63.4 years), we assigned them to a TCI category (low n = 1934, 48%; intermediate n = 1948, 48%, high n = 178, 4%) according to the calculated TCI score ([1-2], [2.5-3.5], [4-6], respectively), and examined the validity of the TCI category in predicting early non-relapse mortality (NRM), 2-year NRM and relapse (REL). In the unadjusted comparison, the TCI index provided a significant risk stratification for d100 and d180 NRM, NRM and REL risk. In the multivariate analysis adjusted for significant variables, there was an independent association of TCI with early NRM, NRM and REL. In summary, we confirm in contemporary treated patients that TCI reflects the conditioning regimen related morbidity and anti-leukemic efficacy satisfactorily and across other established prognostic factors.
Collapse
Affiliation(s)
- Alexandros Spyridonidis
- Bone Marrow Transplantation Unit and Institute of Cellular Therapy, University of Patras, Patras, Greece.
| | - Myriam Labopin
- EBMT Unit, Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMRs 938, Paris, France
| | - Tobias Gedde-Dahl
- Oslo University Hospital, Rikshospitalet Clinic for Cancer Medicine, Hematology Dept. Section for Stem Cell Transplantation, Oslo, Norway
| | - Arnold Ganser
- Hannover Medical School, Department of Haematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover, Germany
| | | | - Charles Craddock
- University Hospital Birmingham NHSTrust, Queen Elizabeth Medical Centre, Edgbaston, Dept. of Haematology, Birmingham, United Kingdom
| | - Eva Maria Wagner-Drouet
- University Medical Center Mainz, Department of Hematology, Oncology and Pneumology, Mainz, Germany
| | - Jurjen Versluis
- Erasmus MC Cancer Institute, University Medical Center Rotterdam, Department of Hematology, Rotterdam, Netherlands
| | - Thomas Schroeder
- University Hospital Essen, Dept. of Bone Marrow Transplantation, Essen, Germany
| | - Igor Wolfgang Blau
- Charité Universitätsmedizin Berlin, Onkologie und Tumorimmunologie, Berlin, Germany
| | - Gerald G Wulf
- Universitaetsklinikum Goettingen, Abteilung Hämatologie und Onkologie, Goettingen, Germany
| | - Peter Dreger
- University of Heidelberg, Medizinische Klinik u. Poliklinik V, Heidelberg, Germany
| | | | - Henrik Sengeloev
- National University Hospital, Bone Marrow Transplant Unit, Copenhagen, Denmark
| | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany
| | - Victoria Potter
- Kings College Hospital, Dept. of Haematological Medicine, King's Denmark Hill Campus, London, United Kingdom
| | | | - Jakob Passweg
- University Hospital Basel, Dept of Hematology, Basel, Switzerland
| | | | - Johan Maertens
- University Hospital Gasthuisberg Dept. of Hematology, Leuven, Belgium
| | - Keith M O Wilson
- University Hospital of Wales, Department of Haematology, Cardiff, United Kingdom
| | - Jean Henri Bourhis
- Gustave Roussy Cancer Campus, Department of Hematology, Villejuif, France
| | - Juergen Finke
- University of Freiburg, Department of Hematology/Oncology, Freiburg, Germany
| | - Eolia Brissot
- Hospital Saint Antoine, Department of Hematology, Paris, France
| | - Ali Bazarbachi
- American University of Beirut-Medical Center, Department of Internal Medicine-Bone Marrow Transplantation Program, Beirut, Lebanon
| | - Sebastian Giebel
- Maria Sklodowska-Curie National Research Institute of Oncology, Department of Hematology, Gliwice, Poland
| | - Bipin P Savani
- Vanderbilt University Medical Center, Department of Hematology, Nashville, TN, USA
| | - Arnon Nagler
- Chaim Sheba Medical Center, Department of Hematology, Tel-Hashomer, Israel
| | - Fabio Ciceri
- Hematology Division, Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - Mohamad Mohty
- EBMT Unit, Sorbonne University, Saint-Antoine Hospital, AP-HP, INSERM UMRs 938, Paris, France
- Hospital Saint Antoine, Department of Hematology, Paris, France
| |
Collapse
|
3
|
Fernandez-Luis S, Gomez Lamas D, Cerezo Martin JM, Mora Barrios JM, Yañez San Segundo L, Sanchez Escamilla M, Fernandez-Escalada N, Calvo Sanchez JA, Fernandez Garcia S, Dominguez-Garcia JJ, Colorado Araujo M, Lopez-Duarte M, Martin-Sanchez G, Insunza Gaminde A, Romon Alonso JI, Lobeira Rubio R, Arroyo Rodriguez JL, Rueda Ciller B, Hermosilla Fernandez M, Marco Betes V, Ocio EM, Bermudez Rodriguez A. Feasibility of allogeneic hematopoietic stem cell transplantation in advanced age. Ann Hematol 2024; 103:583-591. [PMID: 37923805 DOI: 10.1007/s00277-023-05521-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 10/25/2023] [Indexed: 11/06/2023]
Abstract
Although it is known that increasing age is associated with increased morbidity and mortality in allogeneic transplantation (allo-HSCT), individualization of the process may allow to perform it in progressively older patients.This study analyzed the outcome of 97 patients older than 60 years with a first allo-HSCT performed at our institution between 2011 and 2019.Median age was 66 years (range 60-79) and 15.4% were older than 70 years. The most frequent diagnosis was acute leukemia (50.5%), and 58.8% received a myeloablative conditioning. With a median follow-up of 33.9 months (range 7.9-111.5), at 3-years overall survival (OS) was 50%; progression-free survival (PFS), 46%; cumulative incidence of relapse, 22%; and non-relapse mortality (NRM), 32%. There were no significant differences in OS (p = 0.415), PFS (p = 0.691), cumulative incidence of relapse (p = 0.357) or NRM (p = 0.658) between patients of 60-64 years (n = 37), 65-69 (n = 45) and ≥ 70 years (n = 15). No differences were observed either depending on the intensity of the conditioning regimen in terms of OS (p = 0.858), PFS (p = 0.729), cumulative incidence of relapse (p = 0.416) or NRM (p = 0.270).In conclusion, older adults can safely and effectively undergo allo-HSCT with proper patient selection and individualized transplantation procedures.
Collapse
Affiliation(s)
- Sara Fernandez-Luis
- Hematology Department, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain.
| | - David Gomez Lamas
- Hematology Department, Hospital Universitario Basurto, Bilbao, Spain
| | | | | | - Lucrecia Yañez San Segundo
- Hematology Department, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain
- University of Cantabria, Santander, Spain
| | | | | | | | - Sergio Fernandez Garcia
- Hematology Department, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain
| | | | | | - Monica Lopez-Duarte
- Hematology Department, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain
| | | | - Andres Insunza Gaminde
- Hematology Department, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Jose Iñigo Romon Alonso
- Hematology Department, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Rocio Lobeira Rubio
- Hematology Department, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain
| | | | | | | | | | - Enrique Maria Ocio
- Hematology Department, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain
- University of Cantabria, Santander, Spain
| | - Arancha Bermudez Rodriguez
- Hematology Department, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain
- University of Cantabria, Santander, Spain
| |
Collapse
|
4
|
Weller JF, Lengerke C, Finke J, Schetelig J, Platzbecker U, Einsele H, Schroeder T, Faul C, Stelljes M, Dreger P, Blau IW, Wulf G, Tischer J, Scheid C, Elmaagacli A, Neidlinger H, Flossdorf S, Bornhäuser M, Bethge W, Fleischhauer K, Kröger N, De Wreede LC, Christopeit M. Allogeneic hematopoietic stem cell transplantation in patients aged 60-79 years in Germany (1998-2018): a registry study. Haematologica 2024; 109:431-443. [PMID: 37646665 PMCID: PMC10831926 DOI: 10.3324/haematol.2023.283175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023] Open
Abstract
Incidences of diseases treated with transplantation frequently peak at higher age. The contribution of age to total risk of transplantation has not been estimated amidst an aging society. We compare outcomes of 1,547 patients aged 70-79 years and 9,422 patients aged 60-69 years transplanted 1998-2018 for myeloid, lymphoid and further neoplasia in Germany. To quantify the contribution of population mortality to survival, we derive excess mortality based on a sex-, year- and agematched German population in a multistate model that incorporates relapse and graft-versus-host-disease (GvHD). Overall survival, relapse-free survival (RFS) and GvHD-free-relapse-free survival (GRFS) is inferior in patients aged 70-79 years, compared to patients aged 60-69 years, with 36% (95% Confidence Interval [CI]: 34-39%) versus 43% (41-44%), 32% (30- 35%) versus 36% (35-37%) and 23% (21-26%) versus 27% (26-28%) three years post-transplant (P<0.001). Cumulative incidences of relapse at three years are 27% (25-30%) for patients aged 70-79 versus 29% (29-30%) (60-69 years) (P=0.71), yet the difference in non-relapse mortality (NRM) (40% [38-43%] vs. 35% [34-36%] in patients aged 70-79 vs. 60-69 years) (P<0.001) translates into survival differences. Median OS of patients surviving >1 year relapse-free is 6.7 (median, 95% CI: 4.5-9.4, 70-79 years) versus 9 (8.4-10.1, 60-69 years) years since landmark. Three years after RFS of one year, excess NRM is 14% (95% CI: 12-18%) in patients aged 70-79 versus 12% [11-13%] in patients aged 60-69, while population NRM is 7% (6-7%) versus 3% (3-3%). Mortality for reasons other than relapse, GvHD, or age is as high as 27% (24-29%) and 22% (22-23%) four years after transplantation. In conclusion, survival amongst older patients is adequate after allogeneic stem cell transplantation.
Collapse
Affiliation(s)
- Jan Frederic Weller
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen
| | - Claudia Lengerke
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen
| | - Jürgen Finke
- University Medical Center Freiburg, Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, Freiburg
| | - Johannes Schetelig
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden
| | - Uwe Platzbecker
- Medical Clinic and Policlinic I, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig
| | - Hermann Einsele
- Department of Internal Medicine II, University Hospital of Würzburg, Würzburg
| | - Thomas Schroeder
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center Essen, University Hospital Essen, Essen
| | - Christoph Faul
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen
| | | | - Peter Dreger
- Department of Medicine V, University of Heidelberg, Heidelberg
| | - Igor W Blau
- Medical Clinic, Charité University Medicine Berlin, Berlin
| | - Gerald Wulf
- Hematology and Medical Oncology, University Medicine Göttingen, Göttingen
| | - Johanna Tischer
- Internal Medicine III, Hematology/ Oncology/ Stem Cell Transplantation, Ludwig-Maximilians-University, Munich
| | - Christoph Scheid
- Faculty of Medicine and Cologne University Hospital, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), University of Cologne, Cologne
| | - Ahmet Elmaagacli
- Department of Hematology/Oncology and Stem Cell Transplantation, Asklepios Klinik St. Georg, Hamburg
| | | | - Sarah Flossdorf
- German Registry for Stem Cell Transplantation, DRST, Ulm, Germany; Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Essen
| | - Martin Bornhäuser
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden
| | - Wolfgang Bethge
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen
| | - Katharina Fleischhauer
- German Registry for Stem Cell Transplantation, DRST, Ulm, Germany; Institute for Experimental Cellular Therapy, University Hospital Essen, Essen
| | - Nicolaus Kröger
- German Registry for Stem Cell Transplantation, DRST, Ulm, Germany; Department of Stem Cell Transplantation, University Medical Center Eppendorf, Hamburg
| | - Liesbeth C De Wreede
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands; DKMS Clinical Trials Unit, Dresden
| | - Maximilian Christopeit
- Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen.
| |
Collapse
|
5
|
Harbi S, Brac de la Perriere L, Bouchacourt B, Garciaz S, Pagliardini T, Calmels B, Cecile M, Lefloch AC, Hicheri Y, Hospital MA, Fürst S, Lemarie C, Braticevic C, Legrand F, Bekrieva E, Weiller PJ, Chabannon C, Vey N, Blaise D, Devillier R. Peripheral blood haploidentical hematopoietic cell transplantation for patients aged 70 years and over with acute myeloid leukemia or high-risk myelodysplastic syndrome. Bone Marrow Transplant 2024; 59:101-106. [PMID: 37923831 DOI: 10.1038/s41409-023-02134-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/04/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023]
Abstract
Haploidentical stem cell transplantation (Haplo-SCT) using non-myeloablative conditioning regimen (NMAC) has extended the feasibility of allogeneic transplantation, notably in older patients. However, there is few data specifically focusing on patients aged 70 years and over with AML and MDS. Thus the benefit of transplantation in this population is still debated. Here we report our single center experience of peripheral blood Haplo-SCT with NMAC and post-transplantation cyclophosphamide in AML and MDS patients aged 70 years and over. We analyzed 50 patients (27 AML, 23 MDS) with a median age of 72 years (70-77), 12/50 (24%) with active disease at Haplo-SCT. Cumulative incidence of grade 3-4 acute and moderate or severe chronic GVHD were 6% and 25%, respectively. Non-relapse mortality (NRM) at day +100 was 0%. NRM, relapse, PFS and OS at 3 years were 16%, 18%, 66%, and 69%, respectively. Among patients who were disease free at 2 years post Haplo-SCT, 88% are living without immunosuppressive treatment. Peripheral blood Haplo-SCT is feasible in selected AML/MDS patients over 70 years, without any early NRM. It produces long-term disease control and survival. Thus, age by itself should not be considered as a formal barrier to Haplo-SCT.
Collapse
Affiliation(s)
- Samia Harbi
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Sylvain Garciaz
- Hematology Department, Institut Paoli-Calmettes, Aix Marseille Univ, CNRS, INSERM, CRCM, Marseille, France
| | | | - Boris Calmels
- Cell Therapy Facility, Institut Paoli-Calmettes, CIC-biotherapy, Marseille, France
| | - Maud Cecile
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Anne-Charlotte Lefloch
- Hematology Department, Institut Paoli-Calmettes, Aix Marseille Univ, CNRS, INSERM, CRCM, Marseille, France
| | - Yosr Hicheri
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | | | - Sabine Fürst
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Claude Lemarie
- Cell Therapy Facility, Institut Paoli-Calmettes, CIC-biotherapy, Marseille, France
| | | | - Faezeh Legrand
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | - Elena Bekrieva
- Hematology Department, Institut Paoli-Calmettes, Marseille, France
| | | | - Christian Chabannon
- Cell Therapy Facility, Institut Paoli-Calmettes, CIC-biotherapy, Marseille, France
| | - Norbert Vey
- Hematology Department, Institut Paoli-Calmettes, Aix Marseille Univ, CNRS, INSERM, CRCM, Marseille, France
| | - Didier Blaise
- Hematology Department, Institut Paoli-Calmettes, Aix Marseille Univ, CNRS, INSERM, CRCM, Marseille, France
| | - Raynier Devillier
- Hematology Department, Institut Paoli-Calmettes, Aix Marseille Univ, CNRS, INSERM, CRCM, Marseille, France.
| |
Collapse
|
6
|
Seftel MD, Pasic I, Parmar G, Bucher O, Allan DS, Bhella S, Hay KA, Ikuomola O, Musto G, Prica A, Richardson E, Truong TH, Paulson K. Hematopoietic Cell Transplantation Trends and Outcomes in Canada: A Registry-Based Cohort Study. Curr Oncol 2023; 30:9953-9967. [PMID: 37999143 PMCID: PMC10669983 DOI: 10.3390/curroncol30110723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Background: Hematopoietic cell transplantation (HCT) is an established therapy for hematologic malignancies and serious non-malignant blood disorders. Despite its curative potential, HCT is associated with substantial toxicity and health resource utilization. Effective delivery of HCT requires complex hospital-based care, which limits the number of HCT centres in Canada. In Canada, the quantity, indications, temporal trends, and outcomes of patients receiving HCT are not known. Methods: A retrospective cohort study of first transplants reported to the Cell Therapy Transplant Canada (CTTC) registry between 2000 and 2019. We determined overall survival (OS) and non-relapse mortality (NRM), categorizing the cohort into early (2000-2009) and later (2010-2019) eras to investigate temporal changes. Results: Of 18,046 transplants, 7571 were allogeneic and 10,475 were autologous. Comparing the two eras, allogeneic transplants increased in number by 22.3%, with greater use of matched unrelated donors in the later era. Autologous transplants increased by 10.9%. Temporal improvements in NRM were observed in children and adults. OS improved in pediatric patients and in adults receiving autologous HCT. In adults receiving allogeneic HCT, OS was stable despite the substantially older age of patients in the later era. Interpretation: HCT is an increasingly frequent procedure in Canada which has expanded to serve older adults. Noted improvements in NRM and OS reflect progress in patient and donor selection, preparation for transplant, and post-transplant supportive care. In allogeneic HCT, unrelated donors have become the most frequent donor source, highlighting the importance of the continued growth of volunteer donor registries. These results serve as a baseline measure for quality improvement and health services planning in Canada.
Collapse
Affiliation(s)
- Matthew D. Seftel
- Canadian Blood Services, Vancouver, BC V6H 2N9, Canada; (G.P.); (D.S.A.)
- Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
| | - Ivan Pasic
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (I.P.); (S.B.); (A.P.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Gaganvir Parmar
- Canadian Blood Services, Vancouver, BC V6H 2N9, Canada; (G.P.); (D.S.A.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Oliver Bucher
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - David S. Allan
- Canadian Blood Services, Vancouver, BC V6H 2N9, Canada; (G.P.); (D.S.A.)
- Department of Medicine and Biochemistry, Microbiology & Immunology, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8L6, Canada
| | - Sita Bhella
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (I.P.); (S.B.); (A.P.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Kevin Anthony Hay
- Division of Hematology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada;
- Division of Hematology, Department of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Terry Fox Laboratory, British Columbia Cancer Research Institute, Vancouver, BC V5Z 1L3, Canada
| | - Oluwaseun Ikuomola
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - Grace Musto
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - Anca Prica
- Hans Messner Allogeneic Blood and Marrow Transplantation Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2M9, Canada; (I.P.); (S.B.); (A.P.)
- Faculty of Medicine, University of Toronto, Toronto, ON M5G 2M9, Canada
| | - Erin Richardson
- Department of Epidemiology, CancerCare Manitoba, Winnipeg, MB R3A 1M5, Canada; (O.B.); (O.I.); (G.M.); (E.R.)
| | - Tony H. Truong
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Calgary, Calgary, AB T3B 6A8, Canada;
| | - Kristjan Paulson
- Cell Therapy and Transplant Canada, Winnipeg, MB R3E 0V9, Canada;
- Department of Medical Oncology and Haematology, CancerCare Manitoba, Winnipeg, MB R3E 0V9, Canada
| |
Collapse
|
7
|
Min GJ, Cho BS, Kwag D, Park SS, Park S, Yoon JH, Lee SE, Eom KS, Kim YJ, Lee S, Min CK, Cho SG, Lee JW, Kim HJ. Dynamic changes in physical function during intensive chemotherapy affect transplant outcomes in older adults with AML. Front Oncol 2023; 13:1281782. [PMID: 38023260 PMCID: PMC10661959 DOI: 10.3389/fonc.2023.1281782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Intensive chemotherapy (IC) can affect all geriatric assessment (GA) domains in older adults with acute myeloid leukemia (AML), but data on the effects of these changes on transplant outcomes are lacking. Methods Therefore, we prospectively assessed the prognostic role of GA domains at diagnosis and allogeneic hematopoietic stem cell transplantation (allo-HSCT) in 51 patients with AML aged ≥60 years who achieved complete remission after IC. We performed both baseline and pre-allo-HSCT GA; moreover, physical function, including a short physical performance battery (SPPB), cognitive function, psychological function, nutritional status, and social support were examined. Results All GA domains showed dynamic changes between the two time points. The directions of change were statistically significant for social support, self-reported physical and psychological functions, and distress, but not for nutritional status, cognitive function, or physical function. Among all GA domains at each time point, only poor physical function and its submaneuvers at diagnosis but not at allo-HSCT were significantly associated with inferior survival. In particular, since the direction of change varied between patients, we found that patients whose physical function improved before allo-HSCT were more likely to survive longer than those with persistently impaired SPPB (55.6% vs. 28.6%, p=0.268). Finally, persistent impairment in SPPB (28.6% vs. 65.9%, p=0.006), tandem stand (0% vs. 63.3%, p=0.012), sit-and-stand (41.2% vs. 70.6%, p=0.009), and gait speed (38.5% vs. 68.4%, p=0.027) further strongly predicted inferior survival. Discussion This study showed that IC courses can induce dynamic changes in different directions in the GA domains of each patient and that changes in objectively measured physical function can predict transplant outcomes.
Collapse
Affiliation(s)
- Gi-June Min
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Sik Cho
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Daehun Kwag
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Soo Park
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Silvia Park
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae-Ho Yoon
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Eun Lee
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ki-Seong Eom
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yoo-Jin Kim
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok Lee
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ki Min
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seok-Goo Cho
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong Wook Lee
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hee-Je Kim
- Department of Hematology, Catholic Hematology Hospital, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- Leukemia Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
8
|
Maffini E, Ngoya M, Galimard JE, Harbi S, Kröger N, Platzbecker U, Sengeloev H, Craddock C, Potter V, Choi G, Chevallier P, Stölzel F, Tholouli E, Maertens J, Ciceri F, Cornelissen J, Sanz J, Spyridonidis A, Lanza F, Nagler A, Mohty M. Allogeneic hematopoietic cell transplantation for patients with AML aged 70 years or older in first remission. A study from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2023; 58:1033-1041. [PMID: 37386253 DOI: 10.1038/s41409-023-02027-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 06/04/2023] [Accepted: 06/21/2023] [Indexed: 07/01/2023]
Abstract
Accessibility to allogeneic hematopoietic cell transplantation (HCT) programs for older patients is growing constantly. We report on the clinical outcomes of a group of 701 adults aged ≥70 years, with acute myeloid leukemia (AML) in first complete remission (CR1), who received a first HCT, from HLA-matched sibling donors (MSD), 10/10 HLA-matched unrelated donors (UD), 9/10 HLA-mismatched unrelated donors (mUD) or haploidentical (Haplo) donors. The 2-year overall survival (OS) was 48.1%, leukemia-free survival (LFS) 45.3%, relapse incidence (RI) 25.2%, non-relapse mortality (NRM) 29.5% and GVHD-free, relapse-free survival (GRFS), 33.4%. Compared to MSD, patients transplanted from Haplo and UD presented lower RI (HR 0.46, 95% CI 0.25-0.8, p = 0.02 and HR 0.44, 95% CI: 0.28-0.69, p = 0.001, respectively); this translated into prolonged LFS for Haplo (HR 0.62, 95% CI: 0.39-0.99, p = 0.04). Patients transplanted from mUD exhibited the highest NRM incidence (HR 2.33, 95% CI: 1.26-4.31, p = 0.007). HCT in selected adult CR1 AML patients >70 years is feasible and could be associated with good clinical outcomes. Prospective clinical trials are warranted.
Collapse
Affiliation(s)
- Enrico Maffini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna; Istituto "L. e A. Seràgnoli", Bologna, Italy.
| | - Maud Ngoya
- EBMT ALWP Statistical Unit, Saint Antoine Hospital, Sorbonne University, Paris, France
| | | | - Samia Harbi
- Programme de Transplantation et Therapie Cellulaire, Centre de Recherche en Cancerologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Platzbecker
- Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, University hospital Leipzig, Leipzig, Germany
| | - Henrik Sengeloev
- Bone Marrow Transplant Unit L 4043, National University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Charles Craddock
- Birmingham Centre for Cellular Therapy and Transplantation, Birmingham, UK
| | - Victoria Potter
- Department of Haematological Medicine, Kings College Hospital, King's Denmark Hill Campus, London, UK
| | - Goda Choi
- University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Friedrich Stölzel
- University Hospital Dresden, Medizinische Klinik und Poliklinik I, Dresden, TU Dresden, Germany
| | - Eleni Tholouli
- Haematology Department, Manchester Royal Infirmary, Oxford Road, Manchester, UK
| | - Johan Maertens
- Department of Hematology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - Jan Cornelissen
- Department of Haematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jaime Sanz
- Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Alexandros Spyridonidis
- Bone Marrow Transplantation Unit and Institute of Cellular therapy, University of Patras, Patras, Greece
| | - Francesco Lanza
- Hematology Unit, Ravenna Public Hospital and Romagna Transplant Network, Ravenna, Italy
| | - Arnon Nagler
- Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Ramat-Gan, Israel
| | - Mohamad Mohty
- Clinical Hematology and Cellular Therapy Department, Sorbonne University, Saint Antoine Hospital, INSERM UMRs 938, Paris, France
| |
Collapse
|
9
|
Choi JH, Shukla M, Abdul-Hay M. Acute Myeloid Leukemia Treatment in the Elderly: A Comprehensive Review of the Present and Future. Acta Haematol 2023; 146:431-457. [PMID: 37459852 DOI: 10.1159/000531628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 06/17/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Acute myeloid leukemia (AML) is a disease of the hematopoietic system that remains a therapeutic challenge despite advances in our understanding of the underlying cancer biology in the past decade. It is also an affliction of the elderly that predominantly affects patients over 60 years of age. Standard therapy involves intensive chemotherapy that is often difficult to tolerate in older populations. Fortunately, recent developments in molecular targeting have shown promising results in treating leukemia, paving the way for novel treatment strategies that are easier to tolerate. SUMMARY Venetoclax, a BCL-2 inhibitor, when combined with a hypomethylating agent, has proven to be a highly effective and well-tolerated drug and established itself as a new standard for treating AML in patients who are unfit for standard intensive therapy. Other targeted therapies include clinically proven and FDA-approved agents, such as IDH1/2 inhibitors, FLT3 inhibitors, and Gemtuzumab, as well as newer and more experimental drugs such as magrolimab, PI-kinase inhibitors, and T-cell engaging therapy. Some of the novel agents such as magrolimab and menin inhibitors are particularly promising, providing therapeutic options to a wider population of patients than ever before. Determining who will benefit from intense or novel low-intense therapy remains a challenge, and it requires careful assessment of individual patient's fitness and disease characteristics. KEY MESSAGES This article reviews past and current treatment strategies that harness various mechanisms of leukemia-targeting agents and introduces novel therapies on the horizon aimed at exploring therapeutic options for the elderly and unfit patient population. It also provides a strategy to select the best available therapy for elderly patients with both newly diagnosed and relapsed/refractory AML.
Collapse
Affiliation(s)
- Jun H Choi
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Division of Hematology and Medical Oncology, New York University Perlmutter Cancer Center, New York, New York, USA
| | - Mihir Shukla
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
| | - Maher Abdul-Hay
- Department of Medicine, New York University Grossman School of Medicine, New York, New York, USA
- Division of Hematology and Medical Oncology, New York University Perlmutter Cancer Center, New York, New York, USA
| |
Collapse
|
10
|
Nagler A, Labopin M, Mielke S, Passweg J, Blaise D, Gedde-Dahl T, Cornelissen JJ, Salmenniemi U, Yakoub-Agha I, Reményi P, Socié G, van Gorkom G, Labussière-Wallet H, Huang XJ, Rubio MT, Byrne J, Craddock C, Griškevičius L, Ciceri F, Mohty M. Matched related versus unrelated versus haploidentical donors for allogeneic transplantation in AML patients achieving first complete remission after two induction courses: a study from the ALWP/EBMT. Bone Marrow Transplant 2023; 58:791-800. [PMID: 37045942 DOI: 10.1038/s41409-023-01980-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
We compared transplants (HSCT) from matched related siblings (MSD) with those from matched 10/10 and mismatched 9/10 unrelated (UD) and T-replete haploidentical (Haplo) donors in acute myeloid leukemia (AML) in first complete remission (CR1) achieved after two inductions, a known poor prognostic factor. One thousand two hundred and ninety-five patients were included: MSD (n = 428), UD 10/10 (n = 554), UD 9/10 (n = 135), and Haplo (n = 178). Acute GVHD II-IV was higher in all groups compared to MSD. Extensive chronic (c) GVHD was significantly higher in UD 9/10 (HR = 2.52; 95% CI 1.55-4.11, p = 0.0002) and UD 10/10 (HR = 1.48; 95% CI 1.03-2.13, p = 0.036) and cGVHD all grades were higher in UD 9/10 vs MSD (HR = 1.77; 95% CI 1.26-2.49, p = 0.0009). Non-relapse mortality was higher in all groups compared to MSD. Relapse incidence, leukemia-free, and overall survival did not differ significantly between donor types. Finally, GVHD-free relapse-free survival was lower in HSCT from UD 9/10 (HR = 1.56, 95% CI 1.20-2.03, p = 0.0009) but not in those from UD 10/10 (HR = 1.13, p = 0.22) and Haplo donors (HR = 1.12, p = 0.43) compared to MSD. In conclusion, in AML patients undergoing HSCT in CR1 achieved after two induction courses 10/10 UD and Haplo but not 9/10 UD donors are comparable alternatives to MSD.
Collapse
Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel.
| | - Myriam Labopin
- EBMT Paris Study Office, Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Stephan Mielke
- Department of Cell Therapy and Allogeneic Stem Cell Transplantation (CAST), Department of Laboratory Medicine (LabMED), Karolinska University Hospital and Institutet, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | | | - Didier Blaise
- Programme de Transplantation & Therapie Cellulaire, Centre de Recherche en Cancérologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Tobias Gedde-Dahl
- Clinic for Cancer Medicine, Hematology Department, Section for Stem Cell Transplantation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jan J Cornelissen
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Urpu Salmenniemi
- HUCH Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki, Finland
| | | | - Péter Reményi
- Department of Hematology and Stem Cell Transplant, Dél-pesti Centrumkórház - Országos Hematológiai és Infektológiai Intézet, Budapest, Hungary
| | - Gerard Socié
- Department of Hematology - BMT, Hôpital St. Louis, Paris, France
| | - Gwendolyn van Gorkom
- Department of Internal Medicine, Division of Hematology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Xiao-Jun Huang
- Peking University People's Hospital, Institute of Haematology, Xicheng District, Beijing, China
| | | | - Jenny Byrne
- Nottingham University Hospital, Nottingham, UK
| | - Charles Craddock
- Department of Haematology, University Hospital Birmingham NHS Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK
| | - Laimonas Griškevičius
- Vilnius University Hospital Santaros Klinikos, Haematology, Oncology & Transfusion Center, Vilnius, Lithuania
| | - Fabio Ciceri
- Hematology & Bone Marrow Transplant, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mohamad Mohty
- EBMT Paris Study Office, Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
- Department of Hematology, Hospital Saint Antoine, EBMT Paris Study Office/CEREST-TC, Saint Antoine Hospital, Paris, France
| |
Collapse
|
11
|
Singh J. Cardio-oncology and transplantation for acute myeloid leukemia. Best Pract Res Clin Haematol 2023; 36:101465. [PMID: 37353290 DOI: 10.1016/j.beha.2023.101465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Abstract
Despite the rapidly evolving treatment landscape for acute myeloid leukemia (AML), allogeneic hematopoietic cell transplantation (allo-HCT) remains an important and potentially curative treatment option for many high-risk AML patients. Cardiovascular disease is an important competing risk throughout allo-HCT and a key driver of morbidity and mortality long after treatment. Cardio-oncology is a new discipline in cardiology which provides multidisciplinary care and expertise to complex cancer patients with the aims of optimizing cardiovascular health plus monitoring and treating potential cardiotoxicity related to cancer treatments. As allogeneic HCT techniques get more sophisticated there will be an increase in transplant eligible older patients with a rise in comorbidities including established cardiovascular disease highlighting the need for close collaboration with cardio-oncology specialists from the time of diagnosis through late survivorship.
Collapse
Affiliation(s)
- Jai Singh
- Atrium Health, Sanger Heart & Vascular Institute, 1237 Harding Place, Suite 5200, Charlotte, NC, 28203, USA.
| |
Collapse
|
12
|
Duda K, Wieczorkiewicz-Kabut A, Koclęga A, Zielińska P, Woźniczka K, Krzemień H, Armatys A, Helbig G. Allogeneic hematopoietic stem cell transplantation remains a feasible approach for elderly with acute myeloid leukemia: a 10-year experience. Ann Hematol 2023:10.1007/s00277-023-05226-1. [PMID: 37074379 DOI: 10.1007/s00277-023-05226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 04/10/2023] [Indexed: 04/20/2023]
Abstract
The incidence of AML increases with age. The implementation of reduced intensity conditioning and progress in supportive care enabled to perform allo-HSCT in elderly patients. The main objective of the study was to assess the safety and efficacy of allotransplantation in elderly AML.Forty nine patients (33 males) at median age of 68 years were identified. Data on patients' and transplant's related variables were retrieved from our local transplant registry. Most patients (65%) were transplanted from 10/10-HLA or 9/10-HLA matched unrelated donor, seven patients (14%) received stem cells from matched related donor and ten patients (20%) from haploidentical donor. All patients received reduced-intensity conditioning (RIC). Peripheral blood was a source of stem cells in all patients except one (98%). Acute GVHD developed in 22 patients (44%) with 5 individuals presenting grade III-IV. CMV reactivation was demonstrated in 19 patients (39%) till day + 100. In total, 22 patients (45%) have died. The main causes of death included infectious complications (n = 9), relapse with subsequent chemotherapy resistance (n = 7), steroid-resistant GvHD (n = 4) and other causes (n = 2). Twenty-seven patients (55%) were alive at the last contact, presented full donor chimerism and remained in the complete remission. The probability of OS and relapse-free survival (RFS) were 57% and 81% at 2 years, respectively. Older donor age showed negative impact on relapse. CMV reactivation, the severity of acute graft versus host disease and older donor age negatively influenced survival. Allo-HSCT remains a safe, feasible and effective procedure for elderly AML patients.
Collapse
Affiliation(s)
- Katarzyna Duda
- Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agata Wieczorkiewicz-Kabut
- Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anna Koclęga
- Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Patrycja Zielińska
- Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Woźniczka
- Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Helena Krzemień
- Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anna Armatys
- Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Helbig
- Department of Hematology and Bone Marrow Transplantation, Faculty of Medicine in Katowice, Medical University of Silesia, Katowice, Poland.
| |
Collapse
|
13
|
Impact of age on hospitalization and outcomes post allogeneic hematopoietic cell transplantation outcome, a single center experience. Ann Hematol 2023; 102:917-926. [PMID: 36820907 DOI: 10.1007/s00277-023-05135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023]
Abstract
The outcomes of allogeneic hematopoietic cell transplantation (HCT) in older patients are not well defined. We retrospectively analyzed the outcomes of 332 patients, with the median age of 65 years (range, 60-76), between 2014 and 2019. We categorized them to 3 age groups (G): G1, 60-65 years (n = 175); G2, > 65-70 years (n = 127); and G3, > 70 years (n = 30). The median length of hospitalization during the initial HCT period was 30 days, with a significant difference when stratified by age (p = 0.049). Overall, 183 (58.7%) patients were re-hospitalized within the first 6 months post HCT, and 60 (21.6%) in the second 6-month period. The 2-year OS was 56% in G1, 53% in G2, and 34% in G3 (p = 0.05). The 2-year event-free survival (EFS) was 54% for G1, 49% for G2, and 31% for G3 (p = 0.04). Non-relapse mortality (NRM) at 2 years was 25% in G1, 36% in G2, and 52% in G3 (p = 0.008). In multivariable analysis, patients aged 60-65 years had significantly better EFS (p = 0.04) and had a trend toward lower NRM (p = 0.05) than those aged > 70 years. Re-admission in the first 6 months post HCT had a significant impact on OS, EFS, and NRM. HCT-specific comorbidity index > 3 had significantly affected NRM. Finally, age had a significant influence on length of hospitalization during HCT. In conclusion, patients aged > 70 years have an inferior EFS and higher NRM. This likely related to higher rate of re-admissions due to infectious complications (84%).
Collapse
|
14
|
Tokaz MC, Baldomero H, Cowan AJ, Saber W, Greinix H, Koh MBC, Kröger N, Mohty M, Galeano S, Okamoto S, Chaudhri N, Karduss AJ, Ciceri F, Colturato VAR, Corbacioglu S, Elhaddad A, Force LM, Frutos C, León AGD, Hamad N, Hamerschlak N, He N, Ho A, Huang XJ, Jacobs B, Kim HJ, Iida M, Lehmann L, de Latour RP, Percival MEM, Perdomo M, Rasheed W, Schultz KR, Seber A, Ko BS, Simione AJ, Srivastava A, Szer J, Wood WA, Kodera Y, Nagler A, Snowden JA, Weisdorf D, Passweg J, Pasquini MC, Sureda A, Atsuta Y, Aljurf M, Niederwieser D. An Analysis of the Worldwide Utilization of Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia. Transplant Cell Ther 2023; 29:279.e1-279.e10. [PMID: 36572384 DOI: 10.1016/j.jtct.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/16/2022] [Accepted: 12/16/2022] [Indexed: 12/25/2022]
Abstract
Acute myeloid leukemia (AML) has an aggressive course and a historically dismal prognosis. For many patients, hematopoietic stem cell transplantation (HSCT) represents the best option for cure, but access, utilization, and health inequities on a global scale remain poorly elucidated. We wanted to describe patterns of global HSCT use in AML for a better understanding of global access, practices, and unmet needs internationally. Estimates of AML incident cases in 2016 were obtained from the Global Burden of Disease 2019 study. HSCT activities were collected from 2009 to 2016 by the Worldwide Network for Blood and Marrow Transplantation through its member organizations. The primary endpoint was global and regional use (number of HSCT) and utilization of HSCT (number of HSCT/number of incident cases) for AML. Secondary outcomes included trends from 2009 to 2016 in donor type, stem cell source, and remission status at time of HSCT. Global AML incidence has steadily increased, from 102,000 (95% uncertainty interval: 90,200-108,000) in 2009 to 118,000 (104,000-126,000) in 2016 (16.2%). Over the same period, a 54.9% increase from 9659 to 14,965 HSCT/yr was observed globally, driven by an increase in allogeneic (64.9%) with a reduction in autologous (-34.9%) HSCT. Although the highest numbers of HSCT continue to be performed in high-resource regions, the largest increases were seen in resource-constrained regions (94.6% in Africa/East Mediterranean Region [AFR/EMR]; 34.7% in America-Nord Region [AMR-N]). HSCT utilization was skewed toward high-resource regions (in 2016: AMR-N 18.4%, Europe [EUR] 17.9%, South-East Asia/Western Pacific Region [SEAR/WPR] 11.7%, America-South Region [AMR-S] 4.5%, and AFR/EMR 2.8%). For patients <70 years of age, this difference in utilization was widened; AMR-N had the highest allogeneic utilization rate, increasing from 2009 to 2016 (30.6% to 39.9%) with continued low utilization observed in AFR/EMR (1.7% to 2.9%) and AMR-S (3.5% to 5.4%). Across all regions, total HSCT for AML in first complete remission (CR1) increased (from 44.1% to 59.0%). Patterns of donor stem cell source from related versus unrelated donors varied widely by geographic region. SEAR/WPR had a 130.2% increase in related donors from 2009 to 2016, and >95% HSCT donors in AFR/EMR were related; in comparison, AMR-N and EUR have a predilection for unrelated HSCT. Globally, the allogeneic HSCT stem cell source was predominantly peripheral blood (69.7% of total HSCT in 2009 increased to 78.6% in 2016). Autologous HSCT decreased in all regions from 2009 to 2016 except in SEAR/WPR (18.9%). HSCT remains a central curative treatment modality in AML. Allogeneic HSCT for AML is rising globally, but there are marked variations in regional utilization and practices, including types of graft source. Resource-constrained regions have the largest growth in HSCT use, but utilization rates remain low, with a predilection for familial-related donor sources and are typically offered in CR1. Further studies are necessary to elucidate the reasons, including economic factors, to understand and address these health inequalities and improve discrepancies in use of HSCT as a potentially curative treatment globally.
Collapse
Affiliation(s)
- Molly C Tokaz
- Division of Medical Oncology, University of Washington, Seattle, Washington; Division of Hematology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington.
| | - Helen Baldomero
- University Hospital Basel, Center for International Blood and Marrow Transplant Research, Switzerland
| | - Andrew J Cowan
- Division of Medical Oncology, University of Washington, Seattle, Washington; Division of Hematology, University of Washington, Seattle, Washington
| | - Wael Saber
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Mickey B C Koh
- Infection and Immunity Clinical Academic Group, St George's Hospital and Medical School, London, United Kingdom; Academic Cell Therapy Facility and Programme Health Sciences Authority, Singapore
| | | | - Mohamad Mohty
- Sorbonne University, Hospital Saint Antoine, Paris, France
| | - Sebastian Galeano
- Latin American Blood and Marrow Transplantation Group - LABMT Hospital Británico, Montevideo, Uruguay
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naeem Chaudhri
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amado J Karduss
- Clínica Las Américas, Latin AmericanBlood and Marrow Transplantation Group- LABMT, Medellín, Colombia
| | - Fabio Ciceri
- University Vita-Salute San Raffaele, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Alaa Elhaddad
- African Blood and Marrow Transplantation Group - AfBMT; Department of Pediatric Oncology and Stem Cell Transplantation Unit, Cairo University, Cairo, Egypt
| | - Lisa M Force
- Division of Pediatric Hematology-Oncology, Department of Pediatrics and Department of Health Metrics Sciences, University of Washington, Seattle, Washington
| | | | | | - Nada Hamad
- Department of Haematology, St. Vincent's Hospital Sydney, School of Clinical Medicine, Faculty of Medicine and Health, UNSW, School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | | | - Naya He
- University Hospital Basel, Center for International Blood and Marrow Transplant Research, Switzerland
| | - Aloysius Ho
- Department of Haematology, Singapore General Hospital, Singapore
| | - Xiao-Jun Huang
- Department of Hematology, Peking University Institute of Hematology, Beijing, China
| | - Ben Jacobs
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hee-Je Kim
- Catholic Hematology Hospital, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Minako Iida
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Leslie Lehmann
- Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | | | - Mary-Elizabeth M Percival
- Division of Hematology, University of Washington, Seattle, Washington; Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | | | - Walid Rasheed
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Kirk R Schultz
- BC Children's Hospital/UBC, Vancouver, British Columbia, Canada
| | - Adriana Seber
- Latin American Blood and Marrow Transplantation Group-LABMT, Bern, Switzerland; Hospital Samaritano - Americas, Sao Paulo Brazil and Pediatric Oncology Institute-Graacc-Unifesp, São Paulo, Brazil
| | - Bor-Sheng Ko
- Department of Hematological Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | | | | | - Jeff Szer
- Australasian Bone Marrow Transplant Recipient Registry (ABMTRR), St. Vincent ́s Hospital Sydney, Sydney, New South Wales, Australia; Peter MacCallum Cancer Center and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - William A Wood
- CIBMTR, University of North Carolina, Chapel Hill, North Carolina
| | - Yoshihisa Kodera
- Department of Promotion for Blood and Marrow Transplantation, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Arnon Nagler
- The Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | - John A Snowden
- Department of Hematology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Daniel Weisdorf
- CIBMTR (Center for International Blood and Marrow Transplant Research), National Marrow Donor Program/Be The Match, Minneapolis, Minnesota; University of Minnesota, Minneapolis, Minnesota
| | - Jakob Passweg
- University Hospital Basel, Center for International Blood and Marrow Transplant Research, Switzerland
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Anna Sureda
- Clinical Hematology Department, Institut Català d'Oncologia-Hospitalet, IDIBELL, Universitat de Barcelona, Barcelona, Spain
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Dietger Niederwieser
- University Leipzig, Leipzig, Germany; Japanese Data Center for Hematopoietic Cell Transplantation, Department of Registry Science for Transplant and Cellular Therapy, Aichi Medical University School of Medicine, Nagakute, Japan; KaunoKlinikos University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
15
|
Ai H, Chao NJ, Rizzieri DA, Huang X, Spitzer TR, Wang J, Guo M, Keating A, Krakow EF, Blaise D, Ma J, Wu D, Reagan J, Gergis U, Duarte RF, Chaudhary PM, Hu K, Yu C, Sun Q, Fuchs E, Cai B, Huang Y, Qiao J, Gottlieb D, Schultz KR, Liu M, Chen X, Chen W, Wang J, Zhang X, Li J, Huang H, Sun Z, Li F, Yang L, Zhang L, Li L, Liu K, Jin J, Liu Q, Liu D, Gao C, Fan C, Wei L, Zhang X, Hu L, Zhang W, Tian Y, Han W, Zhu J, Xiao Z, Zhou D, Zhang B, Jia Y, Zhang Y, Wu X, Shen X, Lu X, Zhan X, Sun X, Xiao Y, Wang J, Shi X, Zheng B, Chen J, Ding B, Wang Z, Zhou F, Zhang M, Zhang Y, Sun J, Xia B, Chen B, Ma L. Expert consensus on microtransplant for acute myeloid leukemia in elderly patients -report from the international microtransplant interest group. Heliyon 2023; 9:e14924. [PMID: 37089296 PMCID: PMC10119710 DOI: 10.1016/j.heliyon.2023.e14924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/05/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
Recent studies have shown that microtransplant (MST) could improve outcome of patients with elderly acute myeloid leukemia (EAML). To further standardize the MST therapy and improve outcomes in EAML patients, based on analysis of the literature on MST, especially MST with EAML from January 1st, 2011 to November 30th, 2022, the International Microtransplant Interest Group provides recommendations and considerations for MST in the treatment of EAML. Four major issues related to MST for treating EAML were addressed: therapeutic principle of MST (1), candidates for MST (2), induction chemotherapy regimens (3), and post-remission therapy based on MST (4). Others included donor screening, infusion of donor cells, laboratory examinations, and complications of treatment.
Collapse
|
16
|
Niederwieser D, Lang T, Krahl R, Heinicke T, Maschmeyer G, Al-Ali HK, Schwind S, Jentzsch M, Cross M, Kahl C, Wolf HH, Sayer H, Schulze A, Dreger P, Hegenbart U, Krämer A, Junghanss C, Mügge LO, Hähling D, Hirt C, Späth C, Peter N, Opitz B, Florschütz A, Reifenrath K, Zojer N, Scholl S, Pönisch W, Heyn S, Vucinic V, Hochhaus A, Aul C, Giagounidis A, Balleisen L, Oldenkott B, Staib P, Kiehl M, Schütte W, Naumann R, Eimermacher H, Dörken B, Sauerland C, Lengfelder E, Hiddemann W, Wörmann B, Müller-Tidow C, Serve H, Schliemann C, Hehlmann R, Berdel WE, Pfirrmann M, Krug U, Hoffmann VS. Different treatment strategies versus a common standard arm (CSA) in patients with newly diagnosed AML over the age of 60 years: a randomized German inter-group study. Ann Hematol 2023; 102:547-561. [PMID: 36695874 PMCID: PMC9977880 DOI: 10.1007/s00277-023-05087-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/01/2023] [Indexed: 01/26/2023]
Abstract
A randomized inter-group trial comparing more intensive treatment strategies to a common standard arm 3 + 7 (CSA) was conducted in patients with non-M3 AML. Untreated patients ≥ 60 years were allocated to the CSA (n = 132) or to the study group arms (n = 1154) of the AMLCG (TAD/HAM versus HAM/HAM ± G-CSF followed by TAD and maintenance) and the OSHO (intermediate-dose ara-C/mitoxantrone followed by ara-C/mitoxantrone). Median age of the 1147 eligible patients was 69 (range 60-87) years. CR/CRi status at 90 days was not significantly different between the CSA (54% (95%CI: 45-64)) and the study group arms (53% (95%CI: 47-60) and 59% (95%CI: 58-63)). The five-year event-free survival (EFS) probability (primary endpoint) was 6.2% (95%CI: 2.7-14.0) in the CSA, 7.6% (95%CI: 4.5-12.8) in study group A and 11.1% (95%CI: 9.0-13.7) in B. The 5-year OS was 17.2% (95%CI: 11.0-26.9), 17.0% (95%CI: 2.0-23.9), and 19.5% (95%CI: 16.7-22.8) in CSA, study group A and B, respectively. Neither study group differed significantly from the CSA regarding EFS, OS, or relapse-free survival. In multivariate analyses, allocation to the treatment strategy was not significantly associated with the time-to-event endpoints. The evaluation of more intensive treatment strategies did not show clinically relevant outcome differences when compared to CSA.
Collapse
Affiliation(s)
- Dietger Niederwieser
- University Leipzig, 04106, Leipzig, Germany. .,Lithuanian University of Health Sciences, Kaunas, Lithuania. .,Aichi Medical University, Nagakute, Japan.
| | - Thomas Lang
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
| | | | - Thomas Heinicke
- Dept. Hematology and Oncology, Otto-Von-Guericke-University, Magdeburg, Germany
| | - Georg Maschmeyer
- Dept. Hematology, Oncology and Palliative Care, Klinikum Ernst Von Bergmann, Potsdam, Germany
| | - Haifa Kathrin Al-Ali
- Department of Internal Medicine IV, Oncology/Hematology, Krukenberg Cancer-Center, University Hospital Halle (Saale), Halle, Germany
| | | | | | | | - Christoph Kahl
- Dept. Internal Medicine, Clinic III - Hematology, Oncology and Palliative Care, Rostock University Medical Center, Rostock, Germany.,Dept. Hematology, Oncology and Palliative Care, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | | | - Herbert Sayer
- Medizinische Klinik (Hämatologie, Stammzelltransplantation, Onkologie), Helios Klinikum Erfurt, Erfurt, Germany
| | | | - Peter Dreger
- Medical Department V, University Hospital, Heidelberg, Germany
| | - Ute Hegenbart
- Medical Department V, University Hospital, Heidelberg, Germany
| | - Alwin Krämer
- Clinical Cooperation Unit Molecular Hematology/Oncology, German Cancer Research Center (DKFZ) and Dept. of Internal Medicine V, University, Heidelberg, Germany
| | - Christian Junghanss
- Department of Medicine, Clinic III (Hematology, Oncology, Palliative Medicine), Rostock University Medical Center, Rostock, Germany
| | - Lars-Olof Mügge
- Innere Medizin III (Hämatologie, Onkologie Und Palliativmedizin), Hospital Zwickau, Germany
| | - Detlev Hähling
- Dept. Hematology and Oncology, Klinikum Schwerin, Schwerin, Germany
| | - Carsten Hirt
- Innere Medizin C, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Christian Späth
- Innere Medizin C, Universitätsmedizin Greifswald, Sauerbruchstraße, 17475, Greifswald, Germany
| | - Norma Peter
- Medizinische Klinik, Carl-Thieme-Klinikum GmbH, Cottbus, Germany
| | - Bernhard Opitz
- St. Elisabeth Und St, Barbara Hospital Halle (Saale), Halle, Germany
| | | | | | - Niklas Zojer
- 1St Medical Department, Center for Oncology and Hematology & Palliative Care, Klinik Ottakring, Vienna, Austria
| | | | | | | | | | | | - Carlo Aul
- Klinik Für Hämatologie Und Onkologie, St. Johannes Hospital, Duisburg, Germany
| | - Aristoteles Giagounidis
- Klinik Für Hämatologie Und Onkologie, St. Johannes Hospital, Duisburg, Germany.,Dept. Oncology, Hematology and Palliative Care, Marienhospital Düsseldorf, Düsseldorf, Germany
| | | | - Bernd Oldenkott
- Dept. Hematology and Oncology, St. Hedwig Krankenhaus Berlin, Berlin, Germany
| | - Peter Staib
- Dept. Hematology/Oncology, St. Antonius Krankenhaus Eschweiler, Eschweiler, Germany
| | - Michael Kiehl
- Dept. Medicine I, Klinikum Frankfurt/Oder, FrankfurtOder, Germany
| | - Wolfgang Schütte
- Dept. Internal Medicine II, Krankenhaus Martha-Maria, Halle, Germany
| | - Ralph Naumann
- Dept. Hematology, Oncology and Palliative Care, St. Marien-Krankenhaus Siegen, Siegen, Germany
| | - Hartmut Eimermacher
- Dept. Hematology and Oncology, Katholisches Krankenhaus Hagen, Hagen, Germany
| | - Bernd Dörken
- Dept. Hematology and Oncology, Charité Campus Virchow, Berlin, Germany
| | - Cristina Sauerland
- Institute of Biometry and Clinical Research, University Hospital Münster, Münster, Germany
| | - Eva Lengfelder
- IIIrd Medical Dept, University Hospital of Mannheim, Mannheim, Germany
| | | | - Bernhard Wörmann
- Division of Hematology, Oncology and Tumour Immunology, Department of Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Deutsche Gesellschaft für Hämatologie und Medizinische Onkologie, Berlin, Germany
| | - Carsten Müller-Tidow
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Dept. of Medicine V, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hubert Serve
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Department of Medicine, Hematology/Oncology, Goethe University, Frankfurt, Germany
| | | | - Rüdiger Hehlmann
- Mannheim, University of Heidelberg, Mannheim, Germany.,European LeukemiaNet, Weinheim, Germany
| | - Wolfgang E Berdel
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany
| | - Markus Pfirrmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
| | - Utz Krug
- Dept. of Medicine A, University Hospital of Münster, Münster, Germany.,Dept. of Medicine 3, Klinikum Leverkusen, Leverkusen, Germany
| | - Verena S Hoffmann
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig Maximilian Universität München, München, Germany
| |
Collapse
|
17
|
Yanada M, Yamasaki S, Konuma T, Mizuno S, Uchida N, Onai D, Fukuda T, Tanaka M, Ozawa Y, Eto T, Ikegame K, Sawa M, Katayama Y, Kawakita T, Onizuka M, Kanda Y, Ichinohe T, Atsuta Y, Yano S. Age and allogeneic hematopoietic cell transplantation outcomes in acute myeloid leukemia. Int J Hematol 2023; 117:398-408. [PMID: 36335534 DOI: 10.1007/s12185-022-03486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
Although several studies have reported significant effects of patient age on outcomes of allogeneic hematopoietic cell transplantation (HCT), the prognostic relevance of age must be determined separately for myeloablative conditioning (MAC) and reduced-intensity conditioning (RIC). We analyzed Japanese nationwide transplantation registry data of patients aged 20-79 years with acute myeloid leukemia who underwent allogeneic HCT using MAC (n = 7525) or RIC (n = 3154) between 2008 and 2019. Patient were divided into six groups by age, with each group representing a decade, and overall survival (OS), relapse, and non-relapse mortality (NRM) were compared between adjacent age groups. The adverse impact of age on OS increased each decade starting at age 40 among patients receiving MAC, but only differed significantly between patients in their 50s and 60s among those receiving RIC. In patients receiving both MAC and RIC, the detrimental effect of advanced age on OS was accompanied by an increased risk of NRM. These findings show that age affects NRM and OS significantly, but differs depending on conditioning intensity. RIC mitigates the adverse prognostic impact of older age and is thus considered a reasonable option for older patients.
Collapse
Affiliation(s)
- Masamitsu Yanada
- Department of Hematology and Cell Therapy, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya, 464-8681, Japan.
| | | | - Takaaki Konuma
- The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | | | | | - Daishi Onai
- Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | | | | | - Yukiyasu Ozawa
- Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, Japan
| | | | | | | | - Yuta Katayama
- Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Toshiro Kawakita
- National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | | | | | - Tatsuo Ichinohe
- Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Aichi Medical University, Nagakute, Japan.,Japanese Data Center for Hematopoietic Cell Transplantation, Nagakute, Japan
| | - Shingo Yano
- The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
18
|
Aghel N, Lui M, Wang V, Khalaf D, Mian H, Hillis C, Walker I, Leber B, Lipton JH, Aljama M, Lepic K, Berg T, Garcia-Horton A, Petropoulos J, Masoom H, Leong DP. Cardiovascular events among recipients of hematopoietic stem cell transplantation-A systematic review and meta-analysis. Bone Marrow Transplant 2023; 58:478-490. [PMID: 36849807 DOI: 10.1038/s41409-023-01928-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 03/01/2023]
Abstract
Cardiovascular diseases are an emerging cause of mortality and morbidity in survivors of hematopoietic stem cell transplantation (HSCT); however, the incidence of cardiovascular events (CVEs) in this population is not well described. This systematic review summarizes the evidence on the incidence of CVEs in HSCT recipients. Medline and Embase were searched from inception to December 2020. Inclusion criteria were cohort studies and phase 3 randomized controlled trials that reported CVEs among adults who underwent HSCT for hematological malignancies. After reviewing 8386 citations, 57 studies were included. The incidence of CVEs at 100 days was 0.19 (95% CI: 0.17-0.21) per 100 person-days after autologous HSCT and 0.06 (95% CI: 0.05-0.07) per 100 person-days after allogeneic HSCT. This higher incidence after autologous HSCT was driven by reports of arrhythmia from one population-based study in patients with multiple myeloma. The incidence of long-term CVEs was 3.98 (95% CI; 3.44-4.63) per 1000 person-years in survivors of autologous HSCT and 3.06 (95% CI; 2.69-3.48) per 1000 person-years in survivors of allogeneic HSCT. CVEs remain an important but under-reported cause of morbidity and mortality in recipients of HSCT. Future studies are required to better understand the incidence and risk factors for CVEs in HSCT recipients.
Collapse
Affiliation(s)
- N Aghel
- Division of Cardiology, Cardio-Oncology Program, McMaster University, and Population Health Research Institute Hamilton, Hamilton, ON, Canada.
| | - M Lui
- Department of Pharmacy, Hamilton Health Sciences, Hamilton, ON, Canada
| | - V Wang
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - D Khalaf
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - H Mian
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - C Hillis
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - I Walker
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - B Leber
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - J H Lipton
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - M Aljama
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - K Lepic
- Department of Hematology, McMaster University, Hamilton, ON, Canada
| | - T Berg
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - A Garcia-Horton
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - J Petropoulos
- Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - H Masoom
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - D P Leong
- Division of Cardiology, Cardio-Oncology Program, McMaster University, and Population Health Research Institute Hamilton, Hamilton, ON, Canada
| |
Collapse
|
19
|
Diagnosis and management of AML in adults: 2022 recommendations from an international expert panel on behalf of the ELN. Blood 2022; 140:1345-1377. [PMID: 35797463 DOI: 10.1182/blood.2022016867] [Citation(s) in RCA: 894] [Impact Index Per Article: 447.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/29/2022] [Indexed: 11/20/2022] Open
Abstract
The 2010 and 2017 editions of the European LeukemiaNet (ELN) recommendations for diagnosis and management of acute myeloid leukemia (AML) in adults are widely recognized among physicians and investigators. There have been major advances in our understanding of AML, including new knowledge about the molecular pathogenesis of AML, leading to an update of the disease classification, technological progress in genomic diagnostics and assessment of measurable residual disease, and the successful development of new therapeutic agents, such as FLT3, IDH1, IDH2, and BCL2 inhibitors. These advances have prompted this update that includes a revised ELN genetic risk classification, revised response criteria, and treatment recommendations.
Collapse
|
20
|
Söderström A, Vonlanthen S, Jönsson-Videsäter K, Mielke S, Lindahl H, Törlén J, Uhlin M. T cell receptor excision circles are potential predictors of survival in adult allogeneic hematopoietic stem cell transplantation recipients with acute myeloid leukemia. Front Immunol 2022; 13:954716. [PMID: 36211398 PMCID: PMC9540498 DOI: 10.3389/fimmu.2022.954716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background Lymphocyte neogenesis from primary lymphoid organs is essential for a successful reconstitution of immunity after allogeneic hematopoietic stem cell transplantation (HSCT). This single-center retrospective study aimed to evaluate T cell receptor excision circles (TREC) and kappa-deleting recombination excision circles (KREC) as surrogate markers for T and B cell recovery, as predictors for transplantation-related outcomes in adult acute myeloid leukemia (AML) patients. Methods Ninety adult patients diagnosed with AML and treated with HSCT between 2010 and 2015 were included in the study. TREC and KREC levels were measured by quantitative PCR at 1, 3, 6, and 12 months after transplantation. Results Overall, excision circle levels increased between 3 and 6 months post-HSCT for TREC (p = 0.005) and 1 and 3 months for KREC (p = 0.0007). In a landmark survival analysis at 12 months post-HSCT, TREC levels were associated with superior overall survival (HR: 0.52, 95% CI: 0.34 - 0.81, p = 0.004). The incidence of viral infections within the first 100 days after transplantation was associated with lower TREC levels at 6 months (p = 0.0002). CMV reactivation was likewise associated with lower TREC levels at 6 months (p = 0.02) post-HSCT. KREC levels were not associated with clinical outcomes in statistical analyzes. Conclusions Results from the present study indicate that TREC measurement could be considered as part of the post-HSCT monitoring to identify AML patients with inferior survival after transplantation. Further prospective studies are warranted to validate these findings.
Collapse
Affiliation(s)
- Anna Söderström
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
- *Correspondence: Anna Söderström,
| | - Sofie Vonlanthen
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Kerstin Jönsson-Videsäter
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Stephan Mielke
- Cell Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Hannes Lindahl
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Johan Törlén
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Cell Therapy and Allogeneic Stem Cell Transplantation, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Uhlin
- Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
21
|
Measurable residual disease (MRD) status before allogeneic hematopoietic cell transplantation impact on secondary acute myeloid leukemia outcome. A Study from the Acute Leukemia Working Party (ALWP) of the European society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2022; 57:1556-1563. [PMID: 35835997 DOI: 10.1038/s41409-022-01748-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 12/21/2022]
Abstract
Measurable residual disease (MRD) assessment before allogeneic hematopoietic cell transplantation (HCT) may help physicians to identify a subgroup of patients at high risk of relapse for de novo acute myeloid leukemia (AML) but its relevance among patients affected by secondary AML (sAML) is still unknown. We assessed the impact of MRD among 318 adult patients with sAML who received an allogeneic HCT in first complete remission. At the time of HCT, a total of 208 (65%) patients achieved MRD negativity, while 110 (35%) had positive MRD. 2-year overall survival (OS) was 58.8 % (95% CI 52.2-64.9) with leukemia-free survival (LFS) of 50.0 % (95% CI 43.7-56.1), relapse incidence of 34.2% (95% CI 28.4-40.1) and non-relapse mortality (NRM) of 23.3 % (95% CI 19-27.7) for the entire cohort. In multivariate analysis, HCT recipients with KPS ≥ 90 experienced less disease recurrence (HR 0.61, 95% CI 0.4-0.94) with better LFS (HR 0.63, 95% CI 0.44-0.89) and OS (HR 0.58, 95% CI 0.39-0.86). There were no differences in major clinical endpoints between patients with MRD-positive and MRD-negative status at the time of HCT. Pre-transplantation assessment of MRD was not informative on post-HCT outcomes in this retrospective registry-based analysis among patients affected by sAML.
Collapse
|
22
|
Indications for haematopoietic cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2022. Bone Marrow Transplant 2022; 57:1217-1239. [PMID: 35589997 PMCID: PMC9119216 DOI: 10.1038/s41409-022-01691-w] [Citation(s) in RCA: 117] [Impact Index Per Article: 58.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/15/2022] [Accepted: 04/20/2022] [Indexed: 12/17/2022]
|
23
|
Alexander T, Greco R. Hematopoietic stem cell transplantation and cellular therapies for autoimmune diseases: overview and future considerations from the Autoimmune Diseases Working Party (ADWP) of the European Society for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 2022; 57:1055-1062. [PMID: 35578014 PMCID: PMC9109750 DOI: 10.1038/s41409-022-01702-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/26/2022] [Accepted: 04/29/2022] [Indexed: 02/06/2023]
Abstract
Autoimmune diseases (ADs) represent a heterogenous group of complex diseases with increasing incidence in Western countries and are a major cause of morbidity. Hematopoietic stem cell transplantation (HSCT) has evolved over the last 25 years as a specific treatment for patients with severe ADs, through eradication of the pathogenic immunologic memory and profound immune renewal. HSCT for ADs is recently facing a unique developmental phase across transplant centers. This review provides a comprehensive overview of the recent evidence and developments in the area, including fundamentals of preclinical research, clinical studies in neurologic, rheumatologic and gastroenterologic diseases, which represent major indications at present, along with evidence of HSCT for rarer indications. Moreover, we describe the interwoven challenges of delivering more advanced cellular therapies, exploiting mesenchymal stem cells, regulatory T cells and potentially CAR-T cell therapies, in patients affected by ADs. Overall, we discuss past and current indications, efficacy, associated risks and benefits, and future directions of HSCT and advanced cellular therapies in the treatment of severe/refractory ADs, integrating the available literature with European Society for Blood and Marrow Transplantation (EBMT) registry data.
Collapse
Affiliation(s)
- Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Berlin, Germany.
| | - Raffaella Greco
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
| |
Collapse
|
24
|
Nagler A, Peczynski C, Dholaria B, Labopin M, Valerius T, Dreger P, Kröger N, Reinhardt HC, Finke J, Franke GN, Ciceri F, Verbeek M, Blau IW, Bornhäuser M, Spyridonidis A, Bug G, Bazarbachi A, Schmid C, Yakoub-Agha I, Savani BN, Mohty M. Impact of conditioning regimen intensity on outcomes of second allogeneic hematopoietic cell transplantation for secondary acute myelogenous leukemia. Bone Marrow Transplant 2022; 57:1116-1123. [PMID: 35501565 DOI: 10.1038/s41409-022-01693-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
Limited data is available on factors impacting the outcomes of second hematopoietic cell transplantation (HCT2) in patients with secondary acute myeloid leukemia (sAML). This study aimed to assess HCT2 outcome for sAML comparing reduced-intensity (RIC) to myeloablative (MAC) conditioning. Two hundred and fifteen patients were included: RIC (n = 134), MAC (n = 81). The median follow-up was 41.1 (95% CI: 26.7-69.3) and 28.5 (95% CI: 23.9-75.4) months, respectively. At two years, the relapse incidence (RI) was 58.3% versus 51.1% in RIC and MAC, respectively. The 2-year leukemia free survival (LFS) was 26.6% versus 26%, and the graft-versus-host disease (GVHD)-free, relapse-free survival (GRFS) was 16.4% versus 12.1%, while OS was 31.4% and 39.7%, for RIC and MAC respectively. MVA showed a significantly lower RI [hazard ratio (HR) = 0.46 (95% CI, 0.26-0.8, p = 0.006)] and improved LFS [HR = 0.62 (95% CI, 0.39-0.98, p = 0.042)] with MAC versus RIC. The choice of conditioning regimen did not impact non-relapse mortality [HR = 1.14 (95% CI, 0.52-2.5, p = 0.74)], overall survival (OS) [HR = 0.72 (95% CI, 0.44-1.17, p = 0.18)] or GRFS [HR = 0.89 (95% CI, 0.59-1.36, p = 0.6)]. In conclusion, MAC was associated with a lower RI and superior LFS. These results support the use of MAC for eligible patients with sAML who are being considered for HCT2.
Collapse
Affiliation(s)
- Arnon Nagler
- Division of Hematology, Sheba Medical Center, Tel Hashomer, Israel
| | | | | | - Myriam Labopin
- Sorbonne University, Sevice d'hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938, Paris, France
| | - Thomas Valerius
- University Medical Center Schleswig Holstein, Campus Kiel, Section for Stem Cell Transplantation and Immunotherapy, Kiel, Germany
| | - Peter Dreger
- University of Heidelberg, Medizinische Klinik u. Poliklinik V, Heidelberg, Germany
| | - Nicolaus Kröger
- University Hospital Eppendorf, Bone Marrow Transplantation Centre, Hamburg, Germany
| | - Hans Christian Reinhardt
- University Duisburg-Essen, University Hospital Essen, Dept. of Bone Marrow Hematology and Stem Cell Transplantation, Essen, Germany
| | - Jürgen Finke
- University of Freiburg, Dept. of Medicine -Hematology, Oncology, Freiburg, Germany
| | - Georg-Nikolaus Franke
- Medical Clinic and Policinic 1, Hematology and Cellular Therapy, University Hospital Leipzig, Leipzig, Germany
| | - Fabio Ciceri
- Ospedale San Raffaele s.r.l., Haematology and BMT, Milano, Italy
| | - Mareike Verbeek
- Klinikum Rechts der Isar, III Med Klinik der TU, Munich, Germany
| | - Igor Wolfgang Blau
- Medizinische Klinik m. S. Hämatologie, Onkologie und Tumorimmunologie, Charité Universitätsmedizin, Berlin, Germany
| | - Martin Bornhäuser
- Universitaetsklinikum Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
| | - Alexandros Spyridonidis
- Hematology Stem Cell Transplant Unit, School of Medicine, University of Patras, Patras, Greece
| | - Gesine Bug
- Department of Medicine 2, Hematology and Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christophe Schmid
- Department of Hematology and Oncology, University Hospital Augsburg, Augsburg, Germany
| | | | - Bipin N Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mohamad Mohty
- Sorbonne University, Sevice d'hématologie Clinique et Thérapie Cellulaire, Hôpital Saint-Antoine, INSERM UMRs 938, Paris, France
| |
Collapse
|
25
|
Huang LW, Sheng Y, Andreadis C, Logan AC, Mannis GN, Smith CC, Gaensler KML, Martin TG, Damon LE, Huang CY, Olin RL. Patterns and predictors of functional decline after alloHCT in older adults. Transplant Cell Ther 2022; 28:309.e1-309.e9. [PMID: 35247612 DOI: 10.1016/j.jtct.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/17/2022] [Accepted: 02/26/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND As allogeneic hematopoietic cell transplantation (alloHCT) is increasingly offered to older adults, geriatric assessments (GA) have been identified as a useful tool for predicting outcomes, particularly functional status. However, very few studies have examined the longitudinal change in GA measures in the post-alloHCT period. OBJECTIVES The objectives of this study are to 1) describe the longitudinal change in GA and QOL measures after alloHCT and to 2) identify predictors of greater functional decline post-transplant. STUDY DESIGN In this single-center prospective cohort study, patients aged 50 years or older planning to undergo alloHCT completed a cancer-specific GA and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT) survey at baseline prior to alloHCT and then at 3, 6, and 12 months after transplant. Changes in GA and QOL measures at each post-transplant time point (3, 6, or 12 months) compared to baseline were analyzed using paired t-tests. Exploration of potential predictors of greater post-transplant functional decline, as measured by instrumental activities of daily living (IADL) and Medical Outcomes Study Physical Health scale (MOS-PH), were examined using linear regressions and chi-squared two-sample test of proportions. RESULTS Mean functional status generally exhibited a pattern of decline at 3 to 6 months post-alloHCT, with recovery to near baseline by 12 months. Mean mental health and emotional QOL were lowest at baseline and improved at all time points post-transplant. Differences in baseline clinical characteristics were not associated with any differences in functional trajectories. Differences in baseline GA measures (patient-rated KPS, IADL, MOS-PH, Timed-Up-and-Go, Blessed Orientation-Memory-Concentration test, Mental Health Inventory 5) also did not predict greater functional decline at 3 months. Patients whose IADL was improved or maintained at 3 months generally maintained their functional status at 6 and 12 months. Similarly, most patients who had IADL decline at 3 months still had functional decline at 6 months, though a portion did have functional recovery by 12 months. Compared to those with improved/maintained IADL at 3 months, those with declined IADL at 3 months were significantly more likely to have persistent functional decline at 6 months (p<0.0001) and 12 months (p=0.02). CONCLUSIONS In older alloHCT patients, mean functional status declines short-term after alloHCT with possibility of recovery by 6 to 12 months, while mean mental and emotional health improve post-alloHCT. Functional decline at 3 months post-alloHCT is associated with persistent functional decline at 12 months.
Collapse
Affiliation(s)
- Li-Wen Huang
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California; Division of Hematology/Oncology, Department of Medicine, San Francisco VA Medical Center, San Francisco, California
| | - Ying Sheng
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Charalambos Andreadis
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Aaron C Logan
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Gabriel N Mannis
- Division of Hematology, Department of Medicine, Stanford University, Stanford, California
| | - Catherine C Smith
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Karin M L Gaensler
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Thomas G Martin
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Lloyd E Damon
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Chiung-Yu Huang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Rebecca L Olin
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.
| |
Collapse
|
26
|
Piemontese S, Lazzari L, Ruggeri A, Marcatti M, Lupo Stanghellini MT, Giglio F, Greco R, Lorentino F, Clerici D, Assanelli A, Farina F, Mastaglio S, Xue E, Marktel S, Vago L, Gentner B, Secco C, Corti C, Carrabba MG, Bernardi M, Peccatori J, Ciceri F. Allogeneic hematopoietic stem cell transplantation in patients older than 65 years with acute myeloid leukemia and myelodysplastic syndrome: a 15-year experience. Bone Marrow Transplant 2022; 57:678-680. [DOI: 10.1038/s41409-022-01600-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 11/09/2022]
|
27
|
Servais S, Beguin Y, Baron F. OUP accepted manuscript. Stem Cells Transl Med 2022; 11:461-477. [PMID: 35438781 PMCID: PMC9154332 DOI: 10.1093/stcltm/szac015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/25/2022] [Indexed: 11/12/2022] Open
Abstract
As in younger patients, allogeneic stem cell transplantation (alloHSCT) offers the best chance for durable remission in older patients (≥60 years) with acute myeloid leukemia (AML). However, defining the best treatment strategy (and in particular, whether or not to proceed to alloHSCT) for elderly patients with AML remains a difficult decision for the hematologist, since potential toxicity of conditioning regimens, risks of graft-versus-host disease, impaired immune reconstitution and the need for prolonged immunosuppression may be of major concern in these vulnerable patients with complex needs. Hopefully, significant progress has been made over the past decade in alloHSCT for elderly patients and current evidence suggests that chronological age per se (between 60 and 75) is not a reliable predictor of outcome after alloHSCT. Here, we review the current state of alloHSCT in elderly patients with AML and also discuss the different approaches currently being investigated to improve both accessibility to as well as success of alloHSCT in these patients.
Collapse
Affiliation(s)
- Sophie Servais
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium
- Hematology Research Unit GIGA-I3, University of Liège, Liège, Belgium
| | - Yves Beguin
- Department of Clinical Hematology, CHU of Liège, Liège, Belgium
- Hematology Research Unit GIGA-I3, University of Liège, Liège, Belgium
| | - Frédéric Baron
- Corresponding author: Baron Frédéric, Clinical Hematology Department, University of Liège, CHU of Liège (Sart-Tilman), 4000 Liège, Belgium. Tel: +32 4 366 72 01;
| |
Collapse
|
28
|
Lin RJ, Artz AS. Allogeneic hematopoietic cell transplantation for older patients. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:254-263. [PMID: 34889392 PMCID: PMC8791130 DOI: 10.1182/hematology.2021000257] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Hematologic malignances are more common and often higher risk in older patients. Allogeneic hematopoietic cell transplantation (alloHCT) best enables long-term disease control for patients with poor risk or relapsed/refractory hematologic malignancies such as acute myeloid leukemia, myelodysplastic syndromes, or myelofibrosis. Rates of alloHCT among older patients, while still relatively low compared with younger patients, have risen sharply over the past decade. Accumulating evidence supports alloHCT for patients ≥60 years of age relative to non-HCT therapies based on improved overall and disease-free survival. However, a significant proportion of older adults have limitations characterized by geriatric assessment. A systematic process to evaluate and optimize older patients may improve decision making, transplant outcomes, and alloHCT access. We present case-based studies to illustrate a stepwise and rational approach to proper older patient evaluation, pretransplant optimization, and posttransplant care with attention to important geriatric issues and quality of life.
Collapse
Affiliation(s)
- Richard J Lin
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | |
Collapse
|
29
|
Appelbaum FR. Effectiveness of allogeneic hematopoietic cell transplantation for older patients with acute myeloid leukemia. Best Pract Res Clin Haematol 2021; 34:101320. [PMID: 34865707 DOI: 10.1016/j.beha.2021.101320] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Outcomes with conventional chemotherapy for older patients with acute myeloid leukemia (AML) remain disappointing, with few cures. For younger patients with AML, allogeneic hematopoietic cell transplantation (HCT) offers the best chance for cure, but this strategy is seldomly used for older patients. With recently improved methodologies, transplantation has become increasingly safe, suggesting that its use in older patients be reconsidered. This report will address four issues: the current frequency of transplantation for AML according to patient age; the impact of patient age on transplant outcomes; the comparative outcomes of transplantation versus chemotherapy for older patients with AML; and possible methods to improve the outcome of allogeneic HCT in older patients with AML.
Collapse
Affiliation(s)
- Frederick R Appelbaum
- University of Washington and the Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue, Seattle, WA, 98109, USA.
| |
Collapse
|
30
|
Malagola M, Polverelli N, Rubini V, Martino M, Patriarca F, Bruno B, Giaccone L, Grillo G, Bramanti S, Bernasconi P, De Gobbi M, Natale A, Terruzzi E, Olivieri A, Chiusolo P, Carella AM, Casini M, Nozzoli C, Mazza P, Bassi S, Onida F, Vacca A, Falcioni S, Luppi M, Iori AP, Pavone V, Skert C, Carluccio P, Borghero C, Proia A, Selleri C, Sacchi N, Mammoliti S, Oldani E, Ciceri F, Russo D, Bonifazi F. GITMO Registry Study on Allogeneic Transplantation in Patients Aged ≥60 Years from 2000 to 2017: Improvements and Criticisms. Transplant Cell Ther 2021; 28:96.e1-96.e11. [PMID: 34818581 DOI: 10.1016/j.jtct.2021.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/13/2021] [Accepted: 11/15/2021] [Indexed: 12/18/2022]
Abstract
Today, allogeneic stem cell transplantation (allo-SCT) can be offered to patients up to age 70 to 72 years and represents one of the most effective curative treatments for many hematologic malignancies. The primary objective of the study was to collect data from the allo-SCTs performed in Italy between 2000 and 2017 in patients aged ≥60 years to evaluate the changes in safety and efficacy outcomes, as well as their distribution and characteristics over time. The Italian Group for Bone Marrow Transplantation, Hematopoietic Stem Cells and Cell Therapy (GITMO) AlloEld study (ClinicalTrials.gov identifier NCT04469985) is a retrospective analysis of allo-SCTs performed at 30 Italian transplantation centers in older patients (age ≥60 years) between 2000 and 2017 (n = 1996). For the purpose of this analysis, patients were grouped into 3 time periods: time A, 2000 to 2005 (n = 256; 12%); time B, 2006 to 2011 (n = 584; 29%); and time C, 2012 to 2017 (n = 1156; 59%). After a median follow-up of 5.6 years, the 5-year nonrelapse mortality (NRM) remained stable (time A, 32.8%; time B, 36.2%; and time C, 35.0%; P = .5), overall survival improved (time A, 28.4%; time B, 31.8%; and time C, 37.3%; P = .012), and the cumulative incidence of relapse was reduced (time A, 45.3%; time B, 38.2%; time C, 30.0%; P < .0001). The 2-year incidence of extensive chronic graft-versus-host disease was reduced significantly (time A, 17.2%; time B, 15.8%; time C, 12.2%; P = .004). Considering times A and B together (2000 to 2011), the 2-year NRM was positively correlated with the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score; NRM was 25.2% in patients with an HCT-CI score of 0, 33.9% in those with a score of 1 or 2, and 36.1% in those with a score of 3 (P < .001). However, after 2012, the HCT-CI score was not significantly predictive of NRM. This study shows that the transplantation procedure in elderly patients became more effective over time. Relapse incidence remains the major problem, and strategies to prevent it are currently under investigation (eg, post-transplantation maintenance). The selection of patients aged ≥60 could be improved by combining HCT-CI and frailty assessment to better predict NRM.
Collapse
Affiliation(s)
- Michele Malagola
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, "ASST-Spedali Civili" Hospital of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
| | - Nicola Polverelli
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, "ASST-Spedali Civili" Hospital of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Vicky Rubini
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, "ASST-Spedali Civili" Hospital of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Massimo Martino
- Stem Cell Transplant and Cellular Therapies Unit, "BMM" Hospital, Reggio Calabria, Italy
| | - Francesca Patriarca
- Hematologic Clinic and Transplant Center, University Hospital of Central Friuli, DAME, University of Udine, Udine, Italy
| | - Benedetto Bruno
- Department of Oncology, SSD Allogeneic Stem Cell Transplantation, "Città della Salute e della Scienza", Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Turin, Italy
| | - Luisa Giaccone
- Department of Oncology, SSD Allogeneic Stem Cell Transplantation, "Città della Salute e della Scienza", Department of Molecular Biotechnology and Health Sciences, Division of Hematology, University of Turin, Turin, Italy
| | - Giovanni Grillo
- Division of Hematology and Marrow Transplant, Niguarda Hospital, Milan, Italy
| | | | - Paolo Bernasconi
- Transplant Center, Unit of Hematology, Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco De Gobbi
- Department of Clinical and Biological Sciences, University of Turin, Internal Medicine and Hematology Division, San Luigi University Hospital - Orbassano (Turin), Italy
| | - Annalisa Natale
- Hematologic Intensive Care, Pescara Hospital, Pescara, Italy
| | | | - Attilio Olivieri
- Haematology Clinic, "Ospedali Riuniti," University Hospital of Ancona, Ancona, Italy
| | - Patrizia Chiusolo
- Department of Medical Imaging, Radiotherapy, Oncology, and Hematology, "A. Gemelli IRCCS" University Teaching Hospital Foundation, Hematology Division, Department of Radiological and Hematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Michele Carella
- SSD Hematologic Intensive Care and Cell Therapy Unit; Department of Medical Sciences, "Casa Sollievo della Sofferenza" Foundation, San Giovanni Rotondo, Italy
| | - Marco Casini
- Hematology and Bone Marrow Transplantation, Bolzano Hospital, Bolzano, Italy
| | - Chiara Nozzoli
- Cell Therapy and Ttransfusion Medicine, "Careggi" University Hospital, Florence, Italy
| | - Patrizio Mazza
- PO San Giuseppe Moscati, Department of Hematology with Transplant Division, ASL Taranto, Italy
| | - Simona Bassi
- Hematology Unit, "G. da Saliceto" Hospital, Piacenza, Italy
| | - Francesco Onida
- IRCCS Foundation "Ospedale Maggiore Ca' Granda Policlinico," University of Milan, Milan, Italy
| | - Adriana Vacca
- Hematology Unit, CTMO PO, "A. Businco", ARNAS Brotzu, Cagliari, Italy
| | - Sadia Falcioni
- Unit of Hematology and Cellular Therapy, "C. e G. Mazzoni" Hospital, Ascoli Piceno, Italy
| | - Mario Luppi
- Department of Medical and Surgical Sciences, UNIMORE, Division of Hematology, Azienda Ospedaliera Universitaria di Modena, Modena, Italy
| | - Anna Paola Iori
- Department of Hematology, Oncology, and Dermatology, "Umberto I" University Hospital, Roma Sapienza University, Rome, Italy
| | - Vincenzo Pavone
- Department of Hematology and Bone Marrow Transplantation, "Card. G. Panico" Hospital, Tricase, Italy
| | - Cristina Skert
- Unit of Hematology/Bone Marrow Transplantation, Unit "Ospedale dell'Angelo" Venice, Mestre, Italy
| | - Paola Carluccio
- Hematology and Stem Cell Transplantation Unit, Department of Emergency and Organ Transplantation, "Aldo Moro" University of Bari, Bari, Italy
| | - Carlo Borghero
- Hematology Department, "San Bortolo" Hospital, Vicenza, Italy
| | - Anna Proia
- Unit of Hematology and Stem Cell Transplant Center, "San Camillo" Hospital, Rome, Italy
| | - Carmine Selleri
- "San Giovanni di Dio e Ruggi d'Aragona" University Hospital, Salerno, Italy
| | - Nicoletta Sacchi
- Italian Bone Marrow Donor Registry, E. O. Galliera Hospitals, Genoa, Italy
| | | | - Elena Oldani
- Hematology Unit, "ASST Papa Giovanni XXIII," Bergamo, Italy
| | - Fabio Ciceri
- Department of Onco-Hematology, Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Domenico Russo
- Blood Diseases and Cell Therapies Unit, Bone Marrow Transplant Unit, "ASST-Spedali Civili" Hospital of Brescia; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | |
Collapse
|
31
|
Evolving Therapeutic Approaches for Older Patients with Acute Myeloid Leukemia in 2021. Cancers (Basel) 2021; 13:cancers13205075. [PMID: 34680226 PMCID: PMC8534216 DOI: 10.3390/cancers13205075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The better understanding of disease biology, the availability of new effective drugs and the increased awareness of patients’ heterogeneity in terms of fitness and personal expectations has made the current treatment paradigm of AML in the elderly very challenging. Here, we discuss the evolving criteria used to define eligibility for induction chemotherapy and transplantation, the introduction of new agents in the treatment of patients with very different clinical conditions, the implications of precision medicine and the importance of quality of life and supportive care, proposing a simplified algorithm that we follow in 2021. Abstract Acute myeloid leukemia (AML) in older patients is characterized by unfavorable prognosis due to adverse disease features and a high rate of treatment-related complications. Classical therapeutic options range from intensive chemotherapy in fit patients, potentially followed by allogeneic hematopoietic cell transplantation (allo-HCT), to hypomethylating agents or palliative care alone for unfit/frail ones. In the era of precision medicine, the treatment paradigm of AML is rapidly changing. On the one hand, a plethora of new targeted drugs with good tolerability profiles are becoming available, offering the possibility to achieve a prolonged remission to many patients not otherwise eligible for more intensive therapies. On the other hand, better tools to assess patients’ fitness and improvements in the selection and management of those undergoing allo-HCT will hopefully reduce treatment-related mortality and complications. Importantly, a detailed genetic characterization of AML has become of paramount importance to choose the best therapeutic option in both intensively treated and unfit patients. Finally, improving supportive care and quality of life is of major importance in this age group, especially for the minority of patients that are still candidates for palliative care because of very poor clinical conditions or unwillingness to receive active treatments. In the present review, we discuss the evolving approaches in the treatment of older AML patients, which is becoming increasingly challenging following the advent of new effective drugs for a very heterogeneous and complex population.
Collapse
|
32
|
Better the cure you know: why patients with AML ≥60 years of age should be offered early allogeneic stem cell transplantation. Blood Adv 2021; 6:1619-1622. [PMID: 34607349 PMCID: PMC8905700 DOI: 10.1182/bloodadvances.2021004829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
33
|
Kunadt D, Stölzel F. Effective Immunosurveillance After Allogeneic Hematopoietic Stem Cell Transplantation in Acute Myeloid Leukemia. Cancer Manag Res 2021; 13:7411-7427. [PMID: 34594134 PMCID: PMC8478160 DOI: 10.2147/cmar.s261721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/15/2021] [Indexed: 12/25/2022] Open
Abstract
The number of patients receiving allogeneic hematopoietic stem cell transplantation (alloHCT) has increased constantly over the last years due to advances in transplant technology development, supportive care, transplant safety, and donor availability. Currently, acute myeloid leukemia (AML) is the most frequent indication for alloHCT. However, disease relapse remains the main cause of therapy failure. Therefore, concepts of maintaining and, if necessary, reinforcing a strong graft-versus-leukemia (GvL) effect is crucial for the prognosis and long-term survival of the patients. Over the last decades, it has become evident that effective immunosurveillance after alloHCT is an entangled complex of donor-specific characteristics, leukemia-associated geno- and phenotypes, and acquired resistance mechanisms. Furthermore, adoption of effector cells such as natural killer (NK) cells, alloreactive and regulatory T-cells with their accompanying receptor repertoire, and cell–cell interactions driven by messenger molecules within the stem cell and the bone marrow niche have important impact. In this review of pre- and posttransplant elements and mechanisms of immunosurveillance, we highlight the most important mechanisms after alloHCT.
Collapse
Affiliation(s)
- Desiree Kunadt
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| | - Friedrich Stölzel
- Department of Internal Medicine I, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
| |
Collapse
|
34
|
Szewczyk NA, Ngo-Huang A, Soones TN, Adekoya LM, Fontillas RC, Ferguson JK, Gale-Capps HE, Kurse BC, Lindsay RJ, Ombres R, Rivera ZR, Gulbis AM, Neumann JL, Braveman BH, Marin D, Shigle TL, Whited L, Wallis WD, Sullivan H, Cao L, Champlin RE, Shpall E, Popat UR. Feasibility and Implementation of a Multimodal Supportive Care Program to Improve Outcomes in Older Patients Undergoing Allogeneic Stem Cell Transplantation. Transplant Cell Ther 2021; 27:1008-1014. [PMID: 34537421 DOI: 10.1016/j.jtct.2021.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/03/2021] [Accepted: 09/08/2021] [Indexed: 11/28/2022]
Abstract
Increasingly, patients age ≥65 years are undergoing allogeneic hematopoietic stem cell transplantation (allo-SCT). Although age alone is a well-documented predictor of overall survival (OS) and nonrelapse mortality (NRM), growing evidence suggests that poor functional status and frailty associated with aging may have roles as well. Our goal in the present study was to identify and improve these and other aging-related maladies by developing a multimodal supportive care program for older allo-SCT recipients. We designed and implemented a multimodal supportive care program, Enhanced Recovery in Stem Cell Transplant (ER-SCT), for patients age ≥65 years undergoing allo-SCT. The ER-SCT program consists of evaluation and critical interventions by key health care providers from multiple disciplines starting before hospital admission for transplantation and extending through 100 days post-allo-SCT. We determined the feasibility of implementing this program in a large stem cell transplantation center. After 1 year of ongoing process improvements, multiple evaluations, and enrollment, we found that a dedicated weekly clinic was necessary to coordinate care and evaluate patients early. We successfully enrolled 57 of 64 eligible patients (89%) in the first year. Our data show that a multimodal supportive care program to enhance recovery for older patients undergoing allo-SCT is feasible. © 2021 American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc.
Collapse
Affiliation(s)
| | - An Ngo-Huang
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tacara N Soones
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Latoya M Adekoya
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Jill K Ferguson
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Brittany C Kurse
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Rachel Ombres
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Zandra R Rivera
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alison M Gulbis
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Joyce L Neumann
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Brent H Braveman
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David Marin
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Laura Whited
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Whitney D Wallis
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hilary Sullivan
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lihui Cao
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Elizabeth Shpall
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Uday R Popat
- The University of Texas MD Anderson Cancer Center, Houston, Texas.
| |
Collapse
|
35
|
Ombres R, des Bordes JKA, Popat UR, Yennu S, Champlin RE, Mohile SG, Kebriaei P, Holmes HM. Serial frailty assessments following allogeneic stem cell transplant in older adults: A pilot study. J Geriatr Oncol 2021; 13:194-199. [PMID: 34493481 DOI: 10.1016/j.jgo.2021.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/02/2021] [Accepted: 08/23/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Increasing numbers of older adults undergo allogeneic stem cell transplantation (SCT) as the only chance of meaningful survival for hematologic malignancies. However, toxicities in vulnerable patients may offset the benefits of SCT. Frailty and abnormal geriatric assessment (GA) prior to SCT have been associated with decreased overall survival in persons aged 60 and older. The purpose of this pilot study was to determine the prevalence of baseline GA deficits and frailty, the prevalence of frailty or death at three and six months after allogeneic SCT, and associations between baseline assessments and the presence of frailty or death post-SCT. METHODS We enrolled 50 patients aged 60 years and older and completed a baseline GA including comorbidity, polypharmacy, nutrition, physical performance, functional status, social support, depression and anxiety, and cognition. Frailty was defined as three or more abnormalities of gait speed, grip strength, weight loss, physical activity, and exhaustion, and was assessed at baseline, three months, and six months after SCT. A composite outcome of frailty or death at three months and six months was analyzed. RESULTS Frailty was present in 11/50 (22%) of patients at baseline. Ten patients did not complete three- month follow-up, and twelve patients did not complete six-month follow-up. Of those with follow-up data, 22 patients (55%) were frail or deceased three months after SCT, and 27 patients (71%) were frail or deceased six months after SCT. Frailty at baseline was not significantly associated with frailty or death at three or six months after SCT. However, the study's small enrollment limits conclusions on these associations. CONCLUSION GA deficits and frailty are prevalent in older adult SCT recipients at baseline and after transplant. Future studies should aim for larger enrollment in order to validate associations between these deficits and outcomes, especially survival, functional status, and quality of life following SCT.
Collapse
Affiliation(s)
- Rachel Ombres
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America.
| | - Jude K A des Bordes
- Department of Family Medicine, McGovern Medical School, Houston, TX, United States of America
| | - Uday R Popat
- Department of Stem Cell Transplant and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Sriram Yennu
- Department of Palliative Care and Rehabilitation Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Richard E Champlin
- Department of Stem Cell Transplant and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Supriya G Mohile
- James Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Partow Kebriaei
- Department of Stem Cell Transplant and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
| | - Holly M Holmes
- Division of Geriatric and Palliative Medicine, McGovern Medical School, Houston, TX, United States of America
| |
Collapse
|
36
|
Fuji S, Kida S, Nakata K, Morishima T, Miyashiro I, Ishikawa J. Long-term trends in the clinical outcomes of patients with acute myeloid leukemia: a population-based real-world data analysis using the Osaka Cancer Registry. Ann Hematol 2021; 100:2717-2725. [PMID: 34477950 DOI: 10.1007/s00277-021-04631-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/01/2021] [Indexed: 12/14/2022]
Abstract
We evaluated the survival patterns for acute myeloid leukemia (AML) patients registered in the Osaka Cancer Registry from 1975 to 2017. During this period, 9706 patients were diagnosed with AML, with a median age of 60 years (range, 0-100). Patients were grouped by age (≤ 20, 21-40, 41-60, 61-70, and ≥ 71) and the year of their diagnosis (1975-1989, 1990-2001, 2002-2010, and 2011-2017). The overall survival (OS) rates of patients of ≤ 60 years of age improved significantly from the period 1975-1989 up to 1990-2001. However, there was a stagnation from 2002-2010 to 2011-2017. In terms of non-acute promyelocytic leukemia patients of > 60 years of age, the improvement of OS was limited during a very long period. In conclusion, the clinical outcome of patients with AML dramatically improved from 1975 to 2001. However, our dataset revealed stagnation in the improvement since 2002. Novel treatment options are needed to further improve the survival of elderly patients.
Collapse
Affiliation(s)
- Shigeo Fuji
- Department of Hematology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka-shi, Osaka, 5418567, Japan.
| | - Shuhei Kida
- Department of Hematology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka-shi, Osaka, 5418567, Japan
| | - Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | | | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Jun Ishikawa
- Department of Hematology, Osaka International Cancer Institute, 3-1-69, Otemae, Chuo-ku, Osaka-shi, Osaka, 5418567, Japan
| |
Collapse
|
37
|
Lazarevic VL. Acute myeloid leukaemia in patients we judge as being older and/or unfit. J Intern Med 2021; 290:279-293. [PMID: 33780573 DOI: 10.1111/joim.13293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 11/29/2022]
Abstract
The definition of older age in AML is arbitrary. In the context of the clinical studies, it starts with age ≥60 or ≥65 years and in recent years ≥70 or 75, depending on the selection of the studied population. In clinical practice, with older age, we often mean that the patient is unfit for intensive chemotherapy. Higher age overlaps with categories such as worse performance status, unfitness, comorbidities, poor-risk cytogenetics, adverse mutation patterns, age-related clonal haematopoiesis and specific disease ontogeny. Intensive induction therapy can result in prolonged overall survival, at least in a subset of elderly patients aged up to 75 years despite the reluctance of some physicians and patients to use treatment regimens perceived as toxic. Venetoclax and azacitidine combination is the new standard of comparison for persons unfit for intensive therapy. New oral hypomethylating agent CC-486 as maintenance therapy led to a prolonged overall survival in a randomized trial of patients ≥55 years of age who were in first complete remission, but not eligible for allogeneic stem cell transplantation. Any therapy is better than no therapy, but a substantial proportion of older patients still receive only palliative care. Making a decision for AML diagnosed in older age should be individualized and shared through the dialog with the patient and relatives or cohabitants, considering medical issues and social factors including personal goals. Although we are witnesses of the advances in basic research and therapy, we are still a very long way from curing older patients with AML.
Collapse
Affiliation(s)
- V Lj Lazarevic
- From the, Department of Hematology, Oncology and Radiation Physics, Stem Cell Center, Skåne University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
38
|
Bazarbachi AH, Labopin M, Kröger N, Brecht A, Blaise D, Clausen J, Fanin R, Einsele H, Cavanna L, Itäla-Remes M, Bulabois CE, Kündgen L, Martin H, Schmid C, Wagner-Drouet EM, Alakel N, Bazarbachi A, Savani B, Nagler A, Mohty M. Predictive Factors for Outcome of First Allogeneic Transplant for Elderly Patients With Acute Lymphoblastic Leukemia. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2021; 21:831-840. [PMID: 34373225 DOI: 10.1016/j.clml.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION/BACKGROUND The treatment of acute lymphoblastic leukemia (ALL) in patients older than 70 is extremely challenging with dismal outcome. Allogeneic stem cell transplantation (alloHCT) has seen many advancements in the last decades showing benefits in younger ALL patients, but this treatment modality is decreasingly used with increasing age due to high treatment-related mortality. PATIENTS AND METHODS We identified 84 ALL patients 70 to 84 years old allografted In 2002 to 2019 from a matched related (23%), unrelated (58%), haploidentical (17%), or cord blood (2%) donor at EBMT participating centers with a median follow-up of 23 months. RESULTS The 2-year relapse incidence (RI) and non-relapse mortality were 37% and 28%, respectively, and 2-year leukemia-free survival (LFS), overall survival (OS) and GVHD-free, relapse-free survival (GRFS) were 35%, 39% and 23%, respectively. The strongest predictor of outcome was disease status at transplant whereby patients in first complete remission (CR1) had >50% 2-year OS, reflected in multivariate analysis (MVA) with significant improvement in RI, LFS, and GRFS (HR 0.23, 0.49, and 0.54, respectively). Furthermore, karnofsky score ≥90 reflective of good functional status positively influenced non-relapse mortality in both univariate and MVA (HR 0.37), and interestingly, donor CMV positivity appeared to negatively affect RI, LFS and OS in univariate analysis and RI in MVA (HR 2.87). CONCLUSION Our data suggest that alloHCT is an option for elderly ALL patients, particularly those carefully selected and transplanted in CR1 especially if failed or without access to novel non-chemotherapy-based approaches.
Collapse
Affiliation(s)
- Abdul Hamid Bazarbachi
- Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France; Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY
| | - Myriam Labopin
- Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France
| | - Nicolaus Kröger
- Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne Brecht
- German Clinic for Diagnistics, KMT Zentrum, Wiesbaden, Germany
| | - Didier Blaise
- Departement D'Hematologie, Programme de Transplantation et de Therapie Cellulaire, Centre de Recherche en Cancerologie de Marseille, Institut Paoli Calmettes, Marseille, France
| | - Johannes Clausen
- Department of Internal Medicine I, Ordensklinikum Linz -Elisabethinen, Linz, Austria
| | - Renato Fanin
- Clinica Ematologica, Azienda sanitaria Universitaria Integrata, DAMe, Università di Udine, Udine, Italy
| | - Herman Einsele
- Department of Internal Medicine II, University Hospital Würzburg, Germany
| | - Luigi Cavanna
- Departments of Oncology-Hematology, Ospedale "G. da Saliceto", Piacenza, Italy.
| | - Maija Itäla-Remes
- Stem Cell Transplantation Unit, HUCH Comprehensive Cancer Center, Helsinki, Finland
| | | | - Lukas Kündgen
- Department of Hematology and Oncology, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Hans Martin
- Department of Medicine II, Goethe University, Frankfurt, Germany
| | - Christof Schmid
- Department of Internal Medicine I, University Hospital Cologne, Cologne, Germany
| | - Eva Maria Wagner-Drouet
- 3rd Medical Department, Hematology, Oncology and Pneumology, University Medical Center Mainz, Mainz, Germany
| | - Nael Alakel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum, Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ali Bazarbachi
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Bipin Savani
- Vanderbilt University Medical Center, Nashville, TN
| | - Arnon Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Mohamad Mohty
- Department of Clinical Hematology and Cellular Therapy, Saint Antoine Hospital, INSERM UMR 938, Sorbonne University, Paris, France.
| |
Collapse
|
39
|
Rosko AE, Cordoba R, Abel G, Artz A, Loh KP, Klepin HD. Advances in Management for Older Adults With Hematologic Malignancies. J Clin Oncol 2021; 39:2102-2114. [PMID: 34043442 PMCID: PMC8260925 DOI: 10.1200/jco.21.00242] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/23/2021] [Accepted: 03/10/2021] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ashley E. Rosko
- Division of Hematology, The Ohio State University, Columbus, OH
| | - Raul Cordoba
- Lymphoma Unit, Department of Hematology, Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
| | - Gregory Abel
- Leukemia Program, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| | - Kah Poh Loh
- James P. Wilmot Cancer Center, Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY
| | - Heidi D. Klepin
- Section on Hematology and Oncology, Wake Forest Baptist Health, Winston-Salem, NC
| |
Collapse
|
40
|
Wildes TM, Artz AS. Characterize, Optimize, and Harmonize: Caring for Older Adults With Hematologic Malignancies. Am Soc Clin Oncol Educ Book 2021; 41:1-9. [PMID: 33979197 DOI: 10.1200/edbk_320141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
With the aging of the population, the number of older adults with hematologic malignancies is growing, and treatment paradigms for these patients are rapidly evolving. Use of allogeneic stem cell transplant has been expanding to include septuagenarians but remains a potentially morbid procedure, creating an opportunity for a geriatric-focused evaluation to improve assessment of the individual's risk in undergoing the procedure. Although age alone should not be the sole determinant for transplant eligibility, geriatric assessment often identifies vulnerabilities that are not captured in assessing performance status and comorbidities alone. Those vulnerabilities may be optimized in an approach employing three sequential steps: characterize resiliency, bolster resilience, and harmonize with patient goals. Data are emerging that show that this approach is associated with lower nonrelapse mortality, shorter length of stay, and better survival after transplant. In older adults with myeloma, treatment recommendations also aim to balance the expected efficacy and toxicity profile and incorporate the patient's goals and preferences. Assessment of frailty allows for more personalized estimates of risk of toxicity. Currently, the European Myeloma Network currently recommends using the International Myeloma Working Group frailty scale as a standard approach to defining frail or at-risk populations with myeloma. In addition to treatment selection, the care of older adults with myeloma must include consideration of other issues, including reducing early mortality with antibiotic prophylaxis, polypharmacy, depression, cognition, and falls. Overall, appreciation of the aging-associated vulnerabilities will allow for the ultimate personalized care and treatment of older adults with hematologic malignancies.
Collapse
Affiliation(s)
| | - Andrew S Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope, Duarte, CA
| |
Collapse
|
41
|
Loke J, Vyas H, Craddock C. Optimizing Transplant Approaches and Post-Transplant Strategies for Patients With Acute Myeloid Leukemia. Front Oncol 2021; 11:666091. [PMID: 33937080 PMCID: PMC8083129 DOI: 10.3389/fonc.2021.666091] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Acute Myeloid Leukemia (AML) is the commonest indication for allogeneic stem cell transplantation (allo-SCT) worldwide. The increasingly important role of allo-SCT in the management of AML has been underpinned by two important advances. Firstly, improvements in disease risk stratification utilizing genetic and Measurable Residual Disease (MRD) technologies permit ever more accurate identification of allo-mandatory patients who are at high risk of relapse if treated by chemotherapy alone. Secondly, increased donor availability coupled with the advent of reduced intensity conditioning (RIC) regimens has substantially expanded transplant access for patients with high risk AML In patients allografted for AML disease relapse continues to represent the commonest cause of transplant failure and the development of novel strategies with the potential to reduce disease recurrence represents a major unmet need.
Collapse
Affiliation(s)
- Justin Loke
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom.,Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Hrushikesh Vyas
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom.,Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| | - Charles Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, United Kingdom.,Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
42
|
Kawakita T, Hirano T, Inoue Y, Irie Y, Sugitani H, Kubota A, Watanabe M, Ueno M, Mitsui N, Yamaguchi S, Inoue Y, Sakai T, Harada N, Matsuoka M, Hidaka M. Feasibility of an intensified myeloablative conditioning regimen consisting of busulfan, fludarabine, cytarabine, and total body irradiation before single cord blood transplantation in elderly patients. Int J Hematol 2021; 114:85-93. [PMID: 33740219 DOI: 10.1007/s12185-021-03131-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/03/2021] [Accepted: 03/09/2021] [Indexed: 12/30/2022]
Abstract
The optimal conditioning regimen for stem cell transplantation in elderly patients remains to be established. We developed a novel preparative regimen using fludarabine 180 mg/m2, intravenous busulfan 12.8 mg/m2, cytarabine 8 g/m2, and 4-Gy total body irradiation before cord blood transplantation (CBT) in patients older than 55 years with various hematological malignancies. All but one patient received graft-versus-host disease (GVHD) prophylaxis consisting of cyclosporine (CsA) and short-term methotrexate (sMTX). Thirty-three patients were included in this study, with a median age of 64 years (range 56-70). The disease risk index was high or very high in 67% of patients, and 73% had a disease status other than complete remission. The probabilities of overall survival and disease-free survival at 3 years were 60 and 57%, respectively. The cumulative incidences of relapse and non-relapse mortality at 3 years were 18 and 25%, respectively. Regimen-related toxicities were generally tolerable. Disease-free survivors (n = 20) stopped immunosuppressants at a median of 7.4 months (range 2.6-25.0), in all cases by the time of the last follow-up. In conclusion, this highly myeloablative conditioning regimen resulted in a high probability of disease-free, GVHD-free, immunosuppressant-free survival after single CBT.(190 words).
Collapse
Affiliation(s)
- Toshiro Kawakita
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan. .,Departments of Hematology, Rheumatology, and Infectious Disease, Kumamoto Univerity Graduate School of Medicine, Kumamoto, Japan.
| | - Taichi Hirano
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Yoshitaka Inoue
- Departments of Hematology, Rheumatology, and Infectious Disease, Kumamoto Univerity Graduate School of Medicine, Kumamoto, Japan
| | - Yumiko Irie
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Hironori Sugitani
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Akira Kubota
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Miho Watanabe
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.,Departments of Hematology, Rheumatology, and Infectious Disease, Kumamoto Univerity Graduate School of Medicine, Kumamoto, Japan
| | - Mitsunori Ueno
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.,Departments of Hematology, Rheumatology, and Infectious Disease, Kumamoto Univerity Graduate School of Medicine, Kumamoto, Japan
| | - Norikazu Mitsui
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Shunichiro Yamaguchi
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan.,Department of Hematology, Arao Municipal Hospital, Kumamoto, Japan
| | - Yoshiko Inoue
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Tatsunori Sakai
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Naoko Harada
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Masao Matsuoka
- Departments of Hematology, Rheumatology, and Infectious Disease, Kumamoto Univerity Graduate School of Medicine, Kumamoto, Japan
| | - Michihiro Hidaka
- Department of Hematology, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| |
Collapse
|
43
|
Isobe M, Konuma T, Masuko M, Uchida N, Miyakoshi S, Sugio Y, Yoshida S, Tanaka M, Matsuhashi Y, Hattori N, Onizuka M, Aotsuka N, Kouzai Y, Wake A, Kimura T, Ichinohe T, Atsuta Y, Yanada M. Single cord blood transplantation for acute myeloid leukemia patients aged 60 years or older: a retrospective study in Japan. Ann Hematol 2021; 100:1849-1861. [PMID: 33624134 DOI: 10.1007/s00277-021-04464-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/15/2021] [Indexed: 12/14/2022]
Abstract
The availability of alternative donor sources could allow elderly patients to receive allogeneic hematopoietic cell transplantation (HCT). We retrospectively evaluated the outcomes of single-unit cord blood transplantation (CBT) in 1577 patients aged ≥60 years with acute myeloid leukemia (AML) in Japan between 2002 and 2017. In total, 990 (63%) patients were not in complete remission (CR) at the time of CBT. A myeloablative conditioning regimen (52%) and calcineurin inhibitor (CI) + mycophenolate mofetil (MMF)-based graft-versus-host disease (GVHD) prophylaxis (45%) were more commonly used. With a median follow-up for survivors of 31 months, the probability of overall survival and the cumulative incidence of leukemia-related mortality at 3 years was 31% and 29%, respectively. The cumulative incidence of non-relapse mortality (NRM) at 100 days and 3 years were 24% and 41%, respectively. The cumulative incidences of grade II-IV and grade III-IV acute GVHD at 100 days and extensive chronic GVHD at 2 years were 44%, 16%, and 14%, respectively. The cumulative incidence of neutrophil engraftment was 80% at 42 days. Results of multivariate analysis indicated that the following factors were significantly associated with higher overall mortality: performance status ≥1, hematopoietic cell transplantation-specific comorbidity index ≥3, adverse cytogenetics, extramedullary disease at diagnosis, and non-CR status at CBT. By contrast, female sex, HLA disparities ≥2, mycophenolate mofetil-based GVHD prophylaxis, and recent CBT were significantly associated with lower overall mortality. In conclusion, single CBT offers a curative option for AML patients aged ≥60 years with careful patient selection.
Collapse
Affiliation(s)
- Masamichi Isobe
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan
| | - Takaaki Konuma
- Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, 4-6-1, Shirokanedai, Minato-ku, Tokyo, 108-8639, Japan.
| | - Masayoshi Masuko
- Department of Hematopoietic Cell Transplantation, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | | | - Yasuhiro Sugio
- Department of Internal Medicine, Kitakyushu City Hospital Organization, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Shuro Yoshida
- Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan
| | - Masatsugu Tanaka
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
| | - Yoshiko Matsuhashi
- Department of Hematology, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Norimichi Hattori
- Division of Hematology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Makoto Onizuka
- Department of Hematology and Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Nobuyuki Aotsuka
- Division of Hematology-Oncology, Japanese Red Cross Society Narita Hospital, Narita, Japan
| | - Yasushi Kouzai
- Department of Transfusion Medicine, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital Kajigaya, Kawasaki, Japan
| | - Takafumi Kimura
- Preparation Department, Japanese Red Cross Kinki Block Blood Center, Osaka, Japan
| | - Tatsuo Ichinohe
- Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan.,Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masamitsu Yanada
- Department of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
| | | |
Collapse
|
44
|
Ringdén O, Remberger M, Törlén J, Finnbogadottir S, Svahn BM, Sadeghi B. Cytokine levels following allogeneic hematopoietic cell transplantation: a match-pair analysis of home care versus hospital care. Int J Hematol 2021; 113:712-722. [PMID: 33544322 DOI: 10.1007/s12185-021-03087-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 12/16/2022]
Abstract
Following allogeneic hematopoietic cell transplantation (HCT), patients living near the hospital were treated at home instead of in isolation in the hospital. We analyzed cytokines using Luminex assays for the first 3 weeks after HCT and compared patients treated at home (n = 42) with matched patients isolated in the hospital (n = 37). In the multivariate analysis, patients treated at home had decreased GM-CSF, IFN-γ (p < 0.01), IL-13, IL-5 (p < 0.05), and IL-2 (p < 0.07). Bloodstream infections, anti-thymocyte globulin, G-CSF treatment, immunosuppression, reduced-intensity conditioning (RIC), related vs. unrelated donors, and graft source affected various cytokine levels. When patients with RIC were analyzed separately, home care patients had reduced G-CSF (p = 0.04) and increased vascular endothelial growth factor (VEGF, p = 0.001) at 3 weeks compared with hospital care patients. Patients with low GM-CSF (p < 0.036) and low IFNγ (p = 0.07) had improved survival. Acute GVHD grades III-IV was seen in 7% and 16% of home care and hospital care patients, respectively. One-year transplantation-related mortality was 7% and 16% and survival at 5 years was 69% and 57% in the two groups, respectively. To conclude, patients treated in the hospital showed varying increased levels of GM-CSF, IFN-γ, IL-13, G-CSF, IL-5, and IL-2 and decreased VEGF, which may contribute to acute GVHD.
Collapse
Affiliation(s)
- Olle Ringdén
- Translational Cell Therapy Research Group (TCR), Department of Pediatrics, CLINTEC, Karolinska Institutet, Kliniskt Forskningscentrum, KFC, NOVUM Plan 6, Hälsovägen 7-9, 141 57, Huddinge, Sweden.
| | - Mats Remberger
- Department of Medical Sciences, Uppsala University and KFUE, Uppsala University Hospital, Uppsala, Sweden
| | - Johan Törlén
- Cell Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Sigrun Finnbogadottir
- Cell Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Britt-Marie Svahn
- Translational Cell Therapy Research Group (TCR), Department of Pediatrics, CLINTEC, Karolinska Institutet, Kliniskt Forskningscentrum, KFC, NOVUM Plan 6, Hälsovägen 7-9, 141 57, Huddinge, Sweden
| | - Behnam Sadeghi
- Translational Cell Therapy Research Group (TCR), Department of Pediatrics, CLINTEC, Karolinska Institutet, Kliniskt Forskningscentrum, KFC, NOVUM Plan 6, Hälsovägen 7-9, 141 57, Huddinge, Sweden
| |
Collapse
|
45
|
Dholaria B, Savani BN, Hamilton BK, Oran B, Liu HD, Tallman MS, Ciurea SO, Holtzman NG, Ii GLP, Devine SM, Mannis G, Grunwald MR, Appelbaum F, Rodriguez C, El Chaer F, Shah N, Hashmi SK, Kharfan-Dabaja MA, DeFilipp Z, Aljurf M, AlShaibani A, Inamoto Y, Jain T, Majhail N, Perales MA, Mohty M, Hamadani M, Carpenter PA, Nagler A. Hematopoietic Cell Transplantation in the Treatment of Newly Diagnosed Adult Acute Myeloid Leukemia: An Evidence-Based Review from the American Society of Transplantation and Cellular Therapy. Transplant Cell Ther 2021; 27:6-20. [PMID: 32966881 DOI: 10.1016/j.bbmt.2020.09.020] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/10/2020] [Indexed: 12/31/2022]
Abstract
The role of hematopoietic cell transplantation (HCT) in the management of newly diagnosed adult acute myeloid leukemia (AML) is reviewed and critically evaluated in this evidence-based review. An AML expert panel, consisting of both transplant and nontransplant experts, was invited to develop clinically relevant frequently asked questions covering disease- and HCT-related topics. A systematic literature review was conducted to generate core recommendations that were graded based on the quality and strength of underlying evidence based on the standardized criteria established by the American Society of Transplantation and Cellular Therapy Steering Committee for evidence-based reviews. Allogeneic HCT offers a survival benefit in patients with intermediate- and high-risk AML and is currently a part of standard clinical care. We recommend the preferential use of myeloablative conditioning in eligible patients. A haploidentical related donor marrow graft is preferred over a cord blood unit in the absence of a fully HLA-matched donor. The evolving role of allogeneic HCT in the context of measurable residual disease monitoring and recent therapeutic advances in AML with regards to maintenance therapy after HCT are also discussed.
Collapse
Affiliation(s)
- Bhagirathbhai Dholaria
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Bipin N Savani
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Betty K Hamilton
- Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Betul Oran
- Department of Stem Cell Transplantation, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hien D Liu
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida
| | | | | | - Noa G Holtzman
- Center for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | | | - Steven M Devine
- National Marrow Donor Program and Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota
| | - Gabriel Mannis
- Department of Medicine, Division of Hematology, Stanford University, Stanford, California
| | - Michael R Grunwald
- Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina
| | - Frederick Appelbaum
- Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington
| | - Cesar Rodriguez
- Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Firas El Chaer
- Division of Hematology/Oncology, University of Virginia, Charlottesville, Virginia
| | - Nina Shah
- Division of Hematology-Oncology, Department of Medicine, University of California San Francisco, San Francisco, California
| | | | - Mohamed A Kharfan-Dabaja
- Division of Hematology-Oncology and Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida
| | - Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts
| | - Mahmoud Aljurf
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - AlFadel AlShaibani
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Yoshihiro Inamoto
- Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington; Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - Tania Jain
- Sidney Kimmel Cancer Center, John Hopkins Hospital, Baltimore, Maryland
| | - Navneet Majhail
- Blood and Marrow Transplant Program, Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Miguel-Angel Perales
- Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Mohamad Mohty
- Saint Antoine Hospital, INSERM UMR 938, Université Pierre et Marie Curie, TC, Paris, France; EBMT Paris Study Office, Paris, France
| | - Mehdi Hamadani
- Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Paul A Carpenter
- Fred Hutchinson Cancer Research Center; Department of Medicine, University of Washington, Seattle, Washington
| | - Arnon Nagler
- EBMT Paris Study Office, Paris, France; Chaim Sheba Medical Center, Tel Hashomer, Israel
| |
Collapse
|
46
|
Koenig K, Mims A, Levis MJ, Horowitz MM. The Changing Landscape of Treatment in Acute Myeloid Leukemia. Am Soc Clin Oncol Educ Book 2020; 40:1-12. [PMID: 32239961 DOI: 10.1200/edbk_279129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The treatment of acute myeloid leukemia is evolving, with increased understanding of molecular pathogenesis allowing better risk stratification and development of new therapies. Tests to identify and drugs to target specific molecular abnormalities are improving remission rates and prolonging survival in patients with high-risk disease. Allogeneic hematopoietic stem cell transplantation remains an important curative therapy, with advances in donor availability and approaches to reduce transplant-related mortality making it applicable in many more patients. Considerations in identifying appropriate patients for targeted therapy and transplantation are presented.
Collapse
Affiliation(s)
- Kristin Koenig
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Alice Mims
- Division of Hematology, Department of Medicine, The Ohio State University and The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - Mark J Levis
- Hematologic Malignancies and Bone Marrow Transplant Program, Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
| | - Mary M Horowitz
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
47
|
Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myeloid Leukemia of the Elderly: Review of Literature and New Perspectives. Mediterr J Hematol Infect Dis 2020; 12:e2020081. [PMID: 33194155 PMCID: PMC7643805 DOI: 10.4084/mjhid.2020.081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/18/2020] [Indexed: 12/31/2022] Open
Abstract
Acute myeloid leukemia (AML) in patients over the age of 60 carries a poor prognosis, mainly due to unsatisfactory control of leukemia with chemotherapy alone. Allogeneic hemopoietic stem cell transplantation (HSCT) would provide significant anti-leukemic effect but is associated with morbidity and mortality, especially in older patients with comorbidities. Reduced-intensity conditioning (RIC) and non-myeloablative (NMA) conditioning regimens have been designed and have led to improved outcomes in this older patient population. New targeted agents, such as Flt3 inhibitors, are currently being used to improve the control of AML further and may be incorporated in a transplant approach. The increasing knowledge of AML in the elderly is currently being associated with a multidimensional approach to identify eligibility and design tailored transplant platforms.
Collapse
|
48
|
Loke J, Labopin M, Craddock C, Niederwieser D, Cornelissen J, Afansayev B, Jindra P, Maertens J, Blaise D, Boriskina K, Gramatzki M, Ganser A, Savani B, Mohty M, Nagler A. Impact of patient: donor HLA disparity on reduced-intensity-conditioned allogeneic stem cell transplants from HLA mismatched unrelated donors for AML: from the ALWP of the EBMT. Bone Marrow Transplant 2020; 56:614-621. [PMID: 33009514 DOI: 10.1038/s41409-020-01072-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/06/2020] [Accepted: 09/21/2020] [Indexed: 11/09/2022]
Abstract
Patients with acute myeloid leukaemia (AML) who lack a matched sibling or unrelated donor commonly undergo transplantation from a donor matched at 9/10 HLA-A, -B, -C, -DRB1, -DQB1 alleles, and it is unclear if a specific locus mismatch is preferable to any other. We therefore studied 937 patients with AML in complete remission transplanted using a reduced intensity conditioning regimen from an unrelated donor mismatched at a single allele. In a multivariate analysis, patient age, adverse karyotype and patient cytomegalovirus (CMV) seropositivity were correlated with decreased leukaemia free survival (LFS) and overall survival (OS). There was no significant difference in LFS or OS between patients transplanted from donors mismatched at HLA-A, -B, -C or -DRB1 in comparison to a HLA-DQB1 mismatched transplant. In a multivariate analysis, patients transplanted with a HLA-A mismatched donor had higher rates of acute graft-versus-host disease (GVHD) and non-relapse mortality (NRM) than patients transplanted with a HLA-DQB1 mismatched donor. Patient CMV seropositivity was associated with an increase in NRM and acute GVHD and reduced LFS and OS, regardless of donor CMV status. For CMV seropositive patients lacking a fully matched donor, alternative GVHD and CMV prophylaxis strategies should be considered.
Collapse
Affiliation(s)
- J Loke
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK
| | - M Labopin
- Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France.,Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris, France
| | - C Craddock
- Centre for Clinical Haematology, Queen Elizabeth Hospital, Birmingham, UK.
| | | | - J Cornelissen
- Erasmus Medical Center-Daniel den Hoed Cancer Center, Rotterdam, The Netherlands
| | - B Afansayev
- State Medical Pavlov University, St. Petersburg, Russia
| | - P Jindra
- Department of Haematology/Oncology, Charles University Hospital, Alej Svobody 80, 304 60, Pilsen, Czech Republic
| | - J Maertens
- Department of Hematology, Acute Leukemia and Transplantation Unit, UZ Leuven, Herestraat 49, B-3000, Leuven, Belgium
| | - D Blaise
- Transplant and Cellular Therapy Unit, Institut Paoli Calmettes, Marseille, France
| | - K Boriskina
- Department of Hematology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - M Gramatzki
- Division of Stem Cell Transplantation and Immunotherapy, University of Kiel, Kiel, Germany
| | - A Ganser
- Department of Haematology, Hemostasis, Oncology, and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str.1, Hannover, Germany
| | - B Savani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Mohty
- Paris EBMT Data Coordination Office, Hospital Saint-Antoine, APHP, Université Pierre et Marie Curie UPMC and INSERM U 938, Paris, France.,Department of Hematology and Cell Therapy, Hospital Saint-Antoine, Paris, France
| | - A Nagler
- Hematology Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| |
Collapse
|
49
|
Olin RL, Fretham C, Pasquini MC, Arora M, Bhatt VR, Derman B, Giralt SA, Huang LW, Koll T, Lee SM, Lin RJ, Pang L, Popat UR, Weisdorf DJ, Artz A. Geriatric assessment in older alloHCT recipients: association of functional and cognitive impairment with outcomes. Blood Adv 2020; 4:2810-2820. [PMID: 32574365 PMCID: PMC7322958 DOI: 10.1182/bloodadvances.2020001719] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/19/2020] [Indexed: 01/01/2023] Open
Abstract
Use of allogeneic hematopoietic cell transplantation (alloHCT) is increasing in older patients with hematologic malignancies. Studies suggest that geriatric assessment (GA), incorporating functional measures such as instrumental activities of daily living (IADL), delineates subtle age-related impairments that enhance risk-stratification. The objective of this multi-institutional retrospective study was to evaluate the prognostic utility of GA metrics collected pre-alloHCT. Eligibility criteria included age ≥50 and pre-alloHCT GA inclusive of at least IADL. Beyond IADL, additional geriatric metrics were collected where available and included Medical Outcomes Study Physical Health score (MOS-PH), Timed Up and Go (TUG), and cognition by Blessed Orientation Memory Concentration (BOMC). Three hundred thirty subjects were included, with a median age of 63 (range 50 to 77). Impairments were frequent: 36% had at least 1 IADL impairment; 14% had TUG ≥13.5 seconds; and 17% had cognitive impairment (BOMC ≥ 7). Median MOS-PH score was 80. IADL and age were not significantly associated with nonrelapse mortality (NRM) or overall survival (OS). In multivariate analysis, only impaired cognition and Hematopoietic Cell Transplant-Comorbidity Index score ≥3 showed an independent association with 1-year NRM (subdistribution hazard ratio [SHR], 2.36; P = .01; and SHR, 2.19; P = .009, respectively). Cognitive impairment independently conferred inferior 1-year OS (hazard ratio, 1.94; P = .01). In a preplanned subgroup analysis in 224 patients aged ≥60 years, cognitive impairment remained the sole GA metric predictive of NRM (2-year NRM: SHR, 2.72; P = .007). These data suggest that cognitive impairment elevates risk of post-alloHCT NRM in older patients.
Collapse
Affiliation(s)
- Rebecca L Olin
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Caitrin Fretham
- Center for International Blood and Marrow Transplant Research, National Marrow Donor Program, Minneapolis, MN
| | - Marcelo C Pasquini
- Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI
| | - Mukta Arora
- Division of Hematology, Oncology, and Transplant, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Vijaya R Bhatt
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE
| | - Benjamin Derman
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, IL
| | - Sergio A Giralt
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Li-Wen Huang
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
- Division of Hematology/Oncology, Department of Medicine, Veterans Affairs Medical Center, San Francisco, CA
| | - Thuy Koll
- Division of Geriatrics, Gerontology, and Palliative Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Sang Mee Lee
- Department of Public Health Sciences, University of Chicago, Chicago, IL
| | - Richard J Lin
- Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Uday R Popat
- Department of Stem Cell Transplantation and Cellular Therapy, MD Anderson Cancer Center, Houston, TX; and
| | - Daniel J Weisdorf
- Division of Hematology, Oncology, and Transplant, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Andrew Artz
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, CA
| |
Collapse
|
50
|
Polverelli N, Tura P, Battipaglia G, Malagola M, Bernardi S, Gandolfi L, Zollner T, Zanaglio C, Farina M, Morello E, Turra A, Mohty M, Russo D. Multidimensional geriatric assessment for elderly hematological patients (≥60 years) submitted to allogeneic stem cell transplantation. A French–Italian 10-year experience on 228 patients. Bone Marrow Transplant 2020; 55:2224-2233. [DOI: 10.1038/s41409-020-0934-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 02/08/2023]
|