Allogeneic Hematopoietic Cell Transplantation in Patients Aged 50 Years or Older with Severe Aplastic Anemia

Autor: Judith C. W. Marsh, Régis Pefault de la Tour, Nicolaus Kröger, Kyle Hebert, Carlo Dufour, Carmel Rice, Ghulam J. Mufti, Jaap Jan Boelens, Nicolaas P. Schaap, Joseph Pidala, Victoria Potter, Neena Kapoor, Paolo Anderlini, Michael Hallek, Eefke Peterson, Andrew McDonald, Mary Eapen, Cora Knol, Herman Einsele, H. Joachim Deeg, Joseph H. Antin, Dirk Jan Eikema, Stijn Halkes, Johanna Tischer, Vikram Mathews, Hein Putter
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
Survival
Cancer development and immune defence Radboud Institute for Molecular Life Sciences [Radboudumc 2]
Premedication
Non-P.H.S
Research Support
U.S. Gov't
P.H.S
Graft vs Host Disease
Research Support
P.H.S
Gastroenterology
Article
N.I.H
Research Support
N.I.H.
Extramural
Internal medicine
medicine
Journal Article
Humans
Transplantation
Homologous
ddc:610
Sibling
Aplastic anemia
Bone Marrow Transplantation
Aged
Hematopoietic cell transplant
Transplantation
Hematology
business.industry
Hazard ratio
Age Factors
Hematopoietic Stem Cell Transplantation
Extramural
Anemia
Aplastic
Middle Aged
medicine.disease
Severe Aplastic Anemia
Survival Analysis
Confidence interval
Calcineurin
Treatment Outcome
Histocompatibility
Female
U.S. Gov't
business
Research Support
U.S. Gov't
Non-P.H.S
Zdroj: Rice, C, Eikema, D J, Marsh, J C W, Knol, C, Hebert, K, Putter, H, Peterson, E, Deeg, H-J, Halkes, C J M, Pidala, J, Anderlini, P, Tischer, J, Kroger, N, McDonald, A, Antin, J H, Schaap, N P M, Hallek, M, Einsele, H, Mathews, V, Kapoor, N, Boelens, J J, Mufti, G J, Potter, V, Pefault de la Tour, R, Eapen, M & Dufour, C 2018, ' Allogeneic Hematopoietic Cell Transplantation in Patients aged 50 years or older with Severe Aplastic Anemia ', BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION . https://doi.org/10.1016/j.bbmt.2018.08.029
Biology of Blood and Marrow Transplantation, 25, 488-495
Biology of Blood and Marrow Transplantation, 25(3), 488. Elsevier Inc.
Biology of Blood and Marrow Transplantation, 25(3), 488-495
Biology of Blood and Marrow Transplantation, 25, 3, pp. 488-495
ISSN: 1083-8791
DOI: 10.1016/j.bbmt.2018.08.029
Popis: We report on 499 patients with severe aplastic anemia aged >= 50 years who underwent hematopoietic cell transplantation (HCT) from HLA-matched sibling (n = 275, 55%) or HLA-matched (8/8) unrelated donors (n =187, 37%) between 2005 and 2016. The median age at HCT was 57.8 years; 16% of patients were 65 to 77 years old. Multivariable analysis confirmed higher mortality risks for patients with performance score less than 90% (hazard ratio HR], 1.41; 95% confidence interval [CI], 1.03 to 1.92; P= .03) and after unrelated donor transplantation (HR, 1.47; 95% CI,1 to 2.16; P = .05). The 3-year probabilities of survival for patients with performance scores of 90 to 100 and less than 90 after HLA-matched sibling transplant were 66% (range, 57% to 75%) and 57% (range, 47% to 76%), respectively. The corresponding probabilities after HLA-matched unrelated donor transplantation were 57% (range, 48% to 67%) and 48% (range, 36% to 59%). Age at transplantation was not associated with survival, but grades II to IV acute graft-versus-host disease (GVHD) risks were higher for patients aged 65 years or older (subdistribution HR [sHR], 1.7; 95% confidence interval, 1.07 to 2.72; P= .026). Chronic GVHD was lower with the GVHD prophylaxis regimens calcineurin inhibitor (CNI) + methotrexate (sHR, .52; 95% CI, .33 to .81; P= .004) and CNI alone or with other agents (sHR, .27; 95% CI, .14 to .53; P < .001) compared with CNI + mycophenolate. Although donor availability is modifiable only to a limited extent, choice of GVHD prophylaxis and selection of patients with good performance scores are key for improved outcomes. (C) 2018 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
Databáze: OpenAIRE
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