BACKGROUND: Transplantation from an HLA-matched sibling is the treatment of choice for young patients with acquired severe aplastic anemia. For older patients, the acceptable upper age limit for transplantation as first-line treatment varies. The current analysis, therefore, sought to identify age or ages at transplantation at which survival differed. DESIGN AND METHODS: We studied the effect of patients' age, adjusting for other significant factors affecting outcomes, in 1307 patients with severe aplastic anemia after HLA-matched sibling transplantation using logistic and Cox regression analysis. Age categories (<20 years, 20-40 years, >40 years) were determined using Martingale residual plots for overall survival and categories based on differences in survival. RESULTS: Patients aged over 40 years old were more likely to have had immunosuppressive therapy, a poor performance score and a longer interval between diagnosis and transplantation. Neutrophil recovery was similar in all age groups but patients aged over 40 years had a lower likelihood of platelet recovery compared to patients aged less than 20 years (OR 0.45, P=0.01) but not compared to those aged 20-40 years (OR 0.60, P=0.10). Compared to the risk of mortality in patients aged less than 20 years, mortality risks were higher in patients over 40 years old (RR 2.70, P<0.0001) and in those aged 20-40 years (RR 1.69, P<0.0001). The mortality risk was also higher in patients aged over 40 years than in those 20-40 years old (RR 1.60, P=0.008). CONCLUSIONS: Mortality risks increased with age. Risks were also higher in patients with a poor performance score and when the interval between diagnosis and transplantation was longer than 3 months, implying earlier referral would be appropriate when this treatment option is being considered.
BACKGROUND: Transplantation from an HLA-matched sibling is the treatment of choice for young patients with acquired severe aplastic anemia. For older patients, the acceptable upper age limit for transplantation as first-line treatment varies. The current analysis, therefore, sought to identify age or ages at transplantation at which survival differed. DESIGN AND METHODS: We studied the effect of patients' age, adjusting for other significant factors affecting outcomes, in 1307 patients with severe aplastic anemia after HLA-matched sibling transplantation using logistic and Cox regression analysis. Age categories (<20 years, 20-40 years, >40 years) were determined using Martingale residual plots for overall survival and categories based on differences in survival. RESULTS:Patients aged over 40 years old were more likely to have had immunosuppressive therapy, a poor performance score and a longer interval between diagnosis and transplantation. Neutrophil recovery was similar in all age groups but patients aged over 40 years had a lower likelihood of platelet recovery compared to patients aged less than 20 years (OR 0.45, P=0.01) but not compared to those aged 20-40 years (OR 0.60, P=0.10). Compared to the risk of mortality in patients aged less than 20 years, mortality risks were higher in patients over 40 years old (RR 2.70, P<0.0001) and in those aged 20-40 years (RR 1.69, P<0.0001). The mortality risk was also higher in patients aged over 40 years than in those 20-40 years old (RR 1.60, P=0.008). CONCLUSIONS: Mortality risks increased with age. Risks were also higher in patients with a poor performance score and when the interval between diagnosis and transplantation was longer than 3 months, implying earlier referral would be appropriate when this treatment option is being considered.
Authors: G Socié; J V Stone; J R Wingard; D Weisdorf; P J Henslee-Downey; C Bredeson; J Y Cahn; J R Passweg; P A Rowlings; H C Schouten; H J Kolb; J P Klein Journal: N Engl J Med Date: 1999-07-01 Impact factor: 91.245
Authors: V Gupta; S E Ball; D Sage; M Ortin; M Freires; E C Gordon-Smith; J C W Marsh Journal: Bone Marrow Transplant Date: 2005-03 Impact factor: 5.483
Authors: Igor B Resnick; Memet Aker; Michael Y Shapira; Panagiotis D Tsirigotis; Menachem Bitan; Ali Abdul-Hai; Simcha Samuel; Aliza Ackerstein; Benjamin Gesundheit; Irina Zilberman; Svetlana Miron; Luba Yoffe; Alex Lvovich; Shimon Slavin; Reuven Or Journal: Br J Haematol Date: 2006-06 Impact factor: 6.998
Authors: Vikas Gupta; Sarah E Ball; Qi-long Yi; Dedorah Sage; Shaun R McCann; Mark Lawler; Miguel Ortin; Mylene Freires; Geoff Hale; Hermann Waldmann; Edward C Gordon-Smith; Judith C W Marsh Journal: Biol Blood Marrow Transplant Date: 2004-12 Impact factor: 5.742
Authors: G Socié; M Henry-Amar; A Bacigalupo; J Hows; A Tichelli; P Ljungman; S R McCann; N Frickhofen; E Van't Veer-Korthof; E Gluckman Journal: N Engl J Med Date: 1993-10-14 Impact factor: 91.245
Authors: Andrea Bacigalupo; Gérard Socié; Hubert Schrezenmeier; Andre Tichelli; Anna Locasciulli; Monika Fuehrer; Antonio M Risitano; Carlo Dufour; Jakob R Passweg; Rosi Oneto; Mahmoud Aljurf; Catherine Flynn; Valerie Mialou; Rose Marie Hamladji; Judith C W Marsh Journal: Haematologica Date: 2012-02-07 Impact factor: 9.941
Authors: Michael J Eckrich; Kwang-Woo Ahn; Richard E Champlin; Peter Coccia; Kamar Godder; John Horan; David Margolis; H Joachim Deeg; Mary Eapen Journal: Am J Hematol Date: 2013-11-15 Impact factor: 10.047