Hematopoietic cell transplantation in older adults: deciding or decision-making?

Artz, Andrew S.; Chow, Selina

doi:10.1038/bmt.2016.86

Cited by 6 publications

(3 citation statements)

References 12 publications

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“…31 Geriatric assessment for evaluation and guided interventions warrant additional research to abrogate morbidity and mortality. 15,32 More precise risk stratification for TRM, if not survival, may paradoxically expand the number of older patients eligible for transplant by delineating a larger pool of patients with acceptable transplant risks. Similar to younger patients, disease relapse remains the primary cause of death in older transplant recipients.…”

Section: Discussionmentioning

confidence: 99%

Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States

Muffly

Pasquini²,

Märtens

et al. 2017

Blood

241

136

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In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. The number and proportion of allografts performed in this population rose markedly over the past decade, accounting for 0.1% of transplants in 2000 to 3.85% (N = 298) in 2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications. Two-year OS and PFS significantly improved over time (OS: 26% [95% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time ( = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; = .006), umbilical cord blood graft (HR, 1.97; = .0002), and myeloablative conditioning (HR, 1.61; = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.

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Section: Discussionmentioning

confidence: 99%

Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States

Muffly

Pasquini²,

Märtens

et al. 2017

Blood

241

136

View full text Add to dashboard Cite

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“…• Pharmacokinetic and pharmacodynamic changes • An increased risk of toxicities and infectious complications from chemotherapeutic agents • An impaired immune system • A high prevalence of comorbid conditions and an overall worse performance status These factors may result in higher risks of non-relapse death after both autologous and allogeneic HCT (Artz and Chow, 2016;Mamdani et al 2016).…”

Section: Older Age Is Still Associated Withmentioning

confidence: 99%

Transplantation Through the Generations

Castagna

Mcmonagle²,

Eeltink

et al. 2017

The European Blood and Marrow Transplantation Textbook for Nurses

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Biologically, a child is a human being between the stages of birth and puberty. The legal definition of child generally refers to a minor, otherwise known as a person younger than the age of majority (Oxford University Press (Accessed 5th January 2013)). The ability to cure children with cancer has radically improved over the recent decades. Today, more than 80% of children with cancer are cured of their disease (Franklin 2014). This incredible achievement is one of the greatest triumphs in the history of medicine and is the result of numerous factors, including developments in paediatric haematopoietic stem cell transplantation (HSCT). Treatment advances for the sick child have been accomplished in various cancer treatments including chemotherapy, surgery, radiotherapy and HSCT. Whilst these therapies have vastly improved outcomes in childhood cancers, there remains scope for further improvement. Keywords HSCT • Paediatric 8.1.1 The Role of EBMT in Paediatric HSCT Changes in HSCT approaches are responsible for progress in this particular area. The role and status of transplantation have evolved. It is no longer considered a salvage therapy for patients in desperate circumstances but is now the treatment of choice for many diseases. The history of paediatric HSCT in Europe began in Poland in 1949 (Raszek-Rosenbusch), with therapeutic transfusion of bone marrow in children with leukaemia and other blood diseases. Subsequent developments in paediatric HSCT were driven on by the creation in 1974, of

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“…A common clinical dilemma for the vulnerable older AML patient is the tendency toward a sluggish pursuit of transplant because of uncertainty about the harms and benefits of transplant. Here, the decision-making process for transplant may be as important as the criteria used [91,92].…”

Section: Timingmentioning

confidence: 99%