PURPOSE: Older age and a previously failed autologous stem-cell transplantation (SCT) are poor prognostic factors for patients receiving myeloablative conditioning and allogeneic SCT. Reduced-intensity conditioning (RIC) regimens achieved a significant reduction of treatment-related mortality, but the influence of previously described risk factors on the outcome of this novel transplantation strategy have not been fully analyzed yet. PATIENTS AND METHODS: One hundred fifty patients with advanced hematologic malignancies received a RIC regimen containing thiotepa (10 mg/kg), fludarabine (60 mg/m2), and cyclophosphamide (60 mg/kg), followed by an allogeneic transplantation from an HLA-identical sibling donor. Patients were divided into two cohorts according to age; 90 patients were younger than 55 years, and 60 patients were 55 years old or older. The other pretransplantation characteristics were fairly balanced. RESULTS: Actuarial 5-year nonrelapse mortality (NRM) rate was not statistically different between the groups (13% in the younger group and 19% in the older group). By univariate and multivariate analysis, NRM was significantly higher in older patients who previously experienced failure with an autograft. The occurrence of grade 3 to 4 acute graft-versus-host disease (GVHD) or extensive chronic GVHD was associated with a higher NRM in both age cohorts. Overall survival (OS) was not statistically different between the younger (66%) and older groups (61%). By multivariate analysis, refractory disease was associated with a worse OS irrespective of age group. CONCLUSION: RIC transplantations show a rather low NRM, and age > or = 55 years per se cannot be considered a risk factor anymore. The timing of transplantation and novel strategies for the prevention of severe GVHD could further improve patient outcome.
PURPOSE: Older age and a previously failed autologous stem-cell transplantation (SCT) are poor prognostic factors for patients receiving myeloablative conditioning and allogeneic SCT. Reduced-intensity conditioning (RIC) regimens achieved a significant reduction of treatment-related mortality, but the influence of previously described risk factors on the outcome of this novel transplantation strategy have not been fully analyzed yet. PATIENTS AND METHODS: One hundred fifty patients with advanced hematologic malignancies received a RIC regimen containing thiotepa (10 mg/kg), fludarabine (60 mg/m2), and cyclophosphamide (60 mg/kg), followed by an allogeneic transplantation from an HLA-identical sibling donor. Patients were divided into two cohorts according to age; 90 patients were younger than 55 years, and 60 patients were 55 years old or older. The other pretransplantation characteristics were fairly balanced. RESULTS: Actuarial 5-year nonrelapse mortality (NRM) rate was not statistically different between the groups (13% in the younger group and 19% in the older group). By univariate and multivariate analysis, NRM was significantly higher in older patients who previously experienced failure with an autograft. The occurrence of grade 3 to 4 acute graft-versus-host disease (GVHD) or extensive chronic GVHD was associated with a higher NRM in both age cohorts. Overall survival (OS) was not statistically different between the younger (66%) and older groups (61%). By multivariate analysis, refractory disease was associated with a worse OS irrespective of age group. CONCLUSION: RIC transplantations show a rather low NRM, and age > or = 55 years per se cannot be considered a risk factor anymore. The timing of transplantation and novel strategies for the prevention of severe GVHD could further improve patient outcome.
Authors: Mohamed L Sorror; Rainer F Storb; Brenda M Sandmaier; Richard T Maziarz; Michael A Pulsipher; Michael B Maris; Smita Bhatia; Fabiana Ostronoff; H Joachim Deeg; Karen L Syrjala; Elihu Estey; David G Maloney; Frederick R Appelbaum; Paul J Martin; Barry E Storer Journal: J Clin Oncol Date: 2014-08-25 Impact factor: 44.544
Authors: Gheath Alatrash; Kelly M Kidwell; Peter F Thall; Antonio Di Stasi; Julianne Chen; Madhushree Zope; Alyssa K Crain; Richard E Champlin; Uday Popat; Elizabeth J Shpall; Roy B Jones; Borje S Andersson Journal: Bone Marrow Transplant Date: 2018-12-10 Impact factor: 5.483
Authors: Brian L McClune; Daniel J Weisdorf; Tanya L Pedersen; Gisela Tunes da Silva; Martin S Tallman; Jorge Sierra; John Dipersio; Armand Keating; Robert P Gale; Biju George; Vikas Gupta; Theresa Hahn; Luis Isola; Madan Jagasia; Hillard Lazarus; David Marks; Richard Maziarz; Edmund K Waller; Chris Bredeson; Sergio Giralt Journal: J Clin Oncol Date: 2010-03-08 Impact factor: 44.544
Authors: Andrea Bacigalupo; Karen Ballen; Doug Rizzo; Sergio Giralt; Hillard Lazarus; Vincent Ho; Jane Apperley; Shimon Slavin; Marcelo Pasquini; Brenda M Sandmaier; John Barrett; Didier Blaise; Robert Lowski; Mary Horowitz Journal: Biol Blood Marrow Transplant Date: 2009-09-01 Impact factor: 5.742
Authors: James M Foran; Steven Z Pavletic; Brent R Logan; Manza A Agovi-Johnson; Waleska S Pérez; Brian J Bolwell; Martin Bornhäuser; Christopher N Bredeson; Mitchell S Cairo; Bruce M Camitta; Edward A Copelan; Jason Dehn; Robert P Gale; Biju George; Vikas Gupta; Gregory A Hale; Hillard M Lazarus; Mark R Litzow; Dipnarine Maharaj; David I Marks; Rodrigo Martino; Richard T Maziarz; Jacob M Rowe; Philip A Rowlings; Bipin N Savani; Mary Lynn Savoie; Jeffrey Szer; Edmund K Waller; Peter H Wiernik; Daniel J Weisdorf Journal: Biol Blood Marrow Transplant Date: 2013-04-28 Impact factor: 5.742