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

Lori Muffly, Marcelo C. Pasquini, Michael Martens, Ruta Brazauskas, Xiaochun Zhu, Kehinde Adekola, Mahmoud Aljurf, Karen K. Ballen, Ashish Bajel, Frederic Baron, Minoo Battiwalla, Amer Beitinjaneh, Jean Yves Cahn, Mathew Carabasi, Yi Bin Chen, Saurabh Chhabra, Stefan Ciurea, Edward Copelan, Anita D’Souza, John EdwardsJames M Foran, Cesar O. Freytes, Henry C. Fung, Robert Peter Gale, Sergio Giralt, Shahrukh K. Hashmi, Gerhard C. Hildebrandt, Vincent Ho, Ann Jakubowski, Hillard Lazarus, Marlise R. Luskin, Rodrigo Martino, Richard Maziarz, Philip McCarthy, Taiga Nishihori, Rebecca Olin, Richard F. Olsson, Attaphol Pawarode, Edward Peres, Andrew R. Rezvani, David Rizzieri, Bipin N. Savani, Harry C. Schouten, Mitchell Sabloff, Matthew Seftel, Sachiko Seo, Mohamed L. Sorror, Jeff Szer, Baldeep M. Wirk, William A. Wood, Andrew Artz

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

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, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .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; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .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.

Original languageEnglish (US)
Pages (from-to)1156-1164
Number of pages9
JournalBlood
Volume130
Issue number9
DOIs
StatePublished - Aug 31 2017

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Transplants
Cell Transplantation
Hematologic Neoplasms
Hazards
Disease-Free Survival
Survival
Confidence Intervals
Blood
Comorbidity
Mortality
Myelodysplastic Syndromes
Grafts
Survival Analysis
Fetal Blood
Allografts
Acute Myeloid Leukemia
Bone Marrow

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

Cite this

Muffly, L., Pasquini, M. C., Martens, M., Brazauskas, R., Zhu, X., Adekola, K., ... Artz, A. (2017). Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. Blood, 130(9), 1156-1164. https://doi.org/10.1182/blood-2017-03-772368

Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. / Muffly, Lori; Pasquini, Marcelo C.; Martens, Michael; Brazauskas, Ruta; Zhu, Xiaochun; Adekola, Kehinde; Aljurf, Mahmoud; Ballen, Karen K.; Bajel, Ashish; Baron, Frederic; Battiwalla, Minoo; Beitinjaneh, Amer; Cahn, Jean Yves; Carabasi, Mathew; Chen, Yi Bin; Chhabra, Saurabh; Ciurea, Stefan; Copelan, Edward; D’Souza, Anita; Edwards, John; Foran, James M; Freytes, Cesar O.; Fung, Henry C.; Gale, Robert Peter; Giralt, Sergio; Hashmi, Shahrukh K.; Hildebrandt, Gerhard C.; Ho, Vincent; Jakubowski, Ann; Lazarus, Hillard; Luskin, Marlise R.; Martino, Rodrigo; Maziarz, Richard; McCarthy, Philip; Nishihori, Taiga; Olin, Rebecca; Olsson, Richard F.; Pawarode, Attaphol; Peres, Edward; Rezvani, Andrew R.; Rizzieri, David; Savani, Bipin N.; Schouten, Harry C.; Sabloff, Mitchell; Seftel, Matthew; Seo, Sachiko; Sorror, Mohamed L.; Szer, Jeff; Wirk, Baldeep M.; Wood, William A.; Artz, Andrew.

In: Blood, Vol. 130, No. 9, 31.08.2017, p. 1156-1164.

Research output: Contribution to journalArticle

Muffly, L, Pasquini, MC, Martens, M, Brazauskas, R, Zhu, X, Adekola, K, Aljurf, M, Ballen, KK, Bajel, A, Baron, F, Battiwalla, M, Beitinjaneh, A, Cahn, JY, Carabasi, M, Chen, YB, Chhabra, S, Ciurea, S, Copelan, E, D’Souza, A, Edwards, J, Foran, JM, Freytes, CO, Fung, HC, Gale, RP, Giralt, S, Hashmi, SK, Hildebrandt, GC, Ho, V, Jakubowski, A, Lazarus, H, Luskin, MR, Martino, R, Maziarz, R, McCarthy, P, Nishihori, T, Olin, R, Olsson, RF, Pawarode, A, Peres, E, Rezvani, AR, Rizzieri, D, Savani, BN, Schouten, HC, Sabloff, M, Seftel, M, Seo, S, Sorror, ML, Szer, J, Wirk, BM, Wood, WA & Artz, A 2017, 'Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States', Blood, vol. 130, no. 9, pp. 1156-1164. https://doi.org/10.1182/blood-2017-03-772368
Muffly, Lori ; Pasquini, Marcelo C. ; Martens, Michael ; Brazauskas, Ruta ; Zhu, Xiaochun ; Adekola, Kehinde ; Aljurf, Mahmoud ; Ballen, Karen K. ; Bajel, Ashish ; Baron, Frederic ; Battiwalla, Minoo ; Beitinjaneh, Amer ; Cahn, Jean Yves ; Carabasi, Mathew ; Chen, Yi Bin ; Chhabra, Saurabh ; Ciurea, Stefan ; Copelan, Edward ; D’Souza, Anita ; Edwards, John ; Foran, James M ; Freytes, Cesar O. ; Fung, Henry C. ; Gale, Robert Peter ; Giralt, Sergio ; Hashmi, Shahrukh K. ; Hildebrandt, Gerhard C. ; Ho, Vincent ; Jakubowski, Ann ; Lazarus, Hillard ; Luskin, Marlise R. ; Martino, Rodrigo ; Maziarz, Richard ; McCarthy, Philip ; Nishihori, Taiga ; Olin, Rebecca ; Olsson, Richard F. ; Pawarode, Attaphol ; Peres, Edward ; Rezvani, Andrew R. ; Rizzieri, David ; Savani, Bipin N. ; Schouten, Harry C. ; Sabloff, Mitchell ; Seftel, Matthew ; Seo, Sachiko ; Sorror, Mohamed L. ; Szer, Jeff ; Wirk, Baldeep M. ; Wood, William A. ; Artz, Andrew. / Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. In: Blood. 2017 ; Vol. 130, No. 9. pp. 1156-1164.
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T1 - Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States

AU - Muffly, Lori

AU - Pasquini, Marcelo C.

AU - Martens, Michael

AU - Brazauskas, Ruta

AU - Zhu, Xiaochun

AU - Adekola, Kehinde

AU - Aljurf, Mahmoud

AU - Ballen, Karen K.

AU - Bajel, Ashish

AU - Baron, Frederic

AU - Battiwalla, Minoo

AU - Beitinjaneh, Amer

AU - Cahn, Jean Yves

AU - Carabasi, Mathew

AU - Chen, Yi Bin

AU - Chhabra, Saurabh

AU - Ciurea, Stefan

AU - Copelan, Edward

AU - D’Souza, Anita

AU - Edwards, John

AU - Foran, James M

AU - Freytes, Cesar O.

AU - Fung, Henry C.

AU - Gale, Robert Peter

AU - Giralt, Sergio

AU - Hashmi, Shahrukh K.

AU - Hildebrandt, Gerhard C.

AU - Ho, Vincent

AU - Jakubowski, Ann

AU - Lazarus, Hillard

AU - Luskin, Marlise R.

AU - Martino, Rodrigo

AU - Maziarz, Richard

AU - McCarthy, Philip

AU - Nishihori, Taiga

AU - Olin, Rebecca

AU - Olsson, Richard F.

AU - Pawarode, Attaphol

AU - Peres, Edward

AU - Rezvani, Andrew R.

AU - Rizzieri, David

AU - Savani, Bipin N.

AU - Schouten, Harry C.

AU - Sabloff, Mitchell

AU - Seftel, Matthew

AU - Seo, Sachiko

AU - Sorror, Mohamed L.

AU - Szer, Jeff

AU - Wirk, Baldeep M.

AU - Wood, William A.

AU - Artz, Andrew

PY - 2017/8/31

Y1 - 2017/8/31

N2 - 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, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .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; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .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.

AB - 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, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .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; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .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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