Age is no longer a barrier to hemopoietic stem cell transplantation (HSCT), but ageism still exists, and many older patients are not being referred for a transplant, even though transplantation offers the only chance of a cure for hematologic malignancies.
Advances in transplant technology have greatly improved success rates, so that the outcomes in older patients are now similar to those seen in younger patients, as shown here in several presentations at the American Society of Hematology (ASH) 55th Annual Meeting.
"However, these advances have not penetrated through to the general oncology community and are not widely appreciated, so the idea persists that transplants are only feasible for younger patients (under 55 years of age)," commented Mary Horowitz, MD, scientific director of the Center for International Blood and Marrow Transplant Resercah (CIBMTR) and chief of the Division of Hematology and Oncology at the Medical College of Wisconsin, in Milwaukee.
"There are many 55- to 65-year-olds who could benefit from a transplant, but these patients are not being referred by their primary oncologist," she commented in an interview with Medscape Medical News. "A 60-year-old now would be expected to live to 85 or so, and if they suddenly develop a life-threatening disease that is curable, well it is worth trying to cure it," she said.
Age Not a Barrier
That chronologic age need no longer be a barrier was illustrated in a study reported at the meeting by Yvette Kasamon, MD, of the Johns Hopkins Kimmel Center in Baltimore, Maryland, and highlighted today in a conference press briefing.
Dr. Kasamon discussed data on 273 patients who underwent a haploidentical, or "half-matched," bone marrow transplant (BMT) without prior myeloablative therapy but with high-dose post- trasplantation cyclophosphamide. These patients had poor-risk hematologic malignancies (56% lymphoma, 35% acute leukemia or myelodysplastic syndrome, 9% other disorders), and 15% of patients had undergone autologous bone marrow transplantation.
"The similarly positive outcomes we observed among patients in their 50s, 60s, and 70s clearly illustrate that advanced age need no longer be a significant barrier to successful outcomes after half-matched BMT," Dr. Kasamon said.
All 3 age groups showed similar 2-year probability of progression-free survival (PFS) and overall survival (OS), and there was also no statistically significant difference in the risk for nonrelapse death or severe graft-vs-host disease.
| Patients' Age (years) | Est 2-Year PFS | Est 2-Year OS |
| 50 - 59 | 39% | 51% |
| 60 - 69 | 36% | 56% |
| 70 - 75 | 39% | 44% |
"These results underscore that a reduced-intensity, related haploidentical transplant should be considered a very reasonable treatment option for suitable patients up to at least age 75 who require a transplant," Dr. Kasamon said. In fact, she added, her clinic has recently raised the age limit to 75 years for a transplant.
However, she also noted that there are not many treatment centers that carry out haploidentical transplantations on a regular basis, and that, age aside, the successful outcomes in this study using this approach represent an advance in their own right.
Until recently, haploidentical transplants carried excessive risk, she pointed out. The use of post-transplant cyclophosphamide for prophylaxis of graft-vs-host disease has been a major advance, she said, and with the use of this treatment, haploidentical transplantation has become a safe and effective treatment in the outpatient setting.
The outcomes with haploidentical transplants with post-transplant cyclophosphamide are now similar to those seen with matched BMT, Dr. Kasamon added.
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