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Impact of age on hospitalization and outcomes post allogeneic hematopoietic cell transplantation outcome, a single center experience

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Abstract

The outcomes of allogeneic hematopoietic cell transplantation (HCT) in older patients are not well defined. We retrospectively analyzed the outcomes of 332 patients, with the median age of 65 years (range, 60–76), between 2014 and 2019. We categorized them to 3 age groups (G): G1, 60–65 years (n = 175); G2, > 65–70 years (n = 127); and G3, > 70 years (n = 30). The median length of hospitalization during the initial HCT period was 30 days, with a significant difference when stratified by age (p = 0.049). Overall, 183 (58.7%) patients were re-hospitalized within the first 6 months post HCT, and 60 (21.6%) in the second 6-month period. The 2-year OS was 56% in G1, 53% in G2, and 34% in G3 (p = 0.05). The 2-year event-free survival (EFS) was 54% for G1, 49% for G2, and 31% for G3 (p = 0.04). Non-relapse mortality (NRM) at 2 years was 25% in G1, 36% in G2, and 52% in G3 (p = 0.008). In multivariable analysis, patients aged 60–65 years had significantly better EFS (p = 0.04) and had a trend toward lower NRM (p = 0.05) than those aged > 70 years. Re-admission in the first 6 months post HCT had a significant impact on OS, EFS, and NRM. HCT-specific comorbidity index > 3 had significantly affected NRM. Finally, age had a significant influence on length of hospitalization during HCT. In conclusion, patients aged > 70 years have an inferior EFS and higher NRM. This likely related to higher rate of re-admissions due to infectious complications (84%).

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Data Availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Vasu S, Kohlschmidt J, Mrózek K, Eisfeld AK, Nicolet D, Sterling LJ et al (2018) Ten-year outcome of patients with acute myeloid leukemia not treated with allogeneic transplantation in first complete remission. Blood Adv 2:1645–1650. https://doi.org/10.1182/bloodadvances.2017015222

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Armitage JO (1994) Bone marrow transplantation Engl. J Med 330(12):827–838. https://doi.org/10.1056/NEJM199403243301206

    Article  CAS  Google Scholar 

  3. McSweeney PA, Niederwieser D, Shizuru JA, Sandmaier BM, Molina AJ, Maloney DG et al (2001) Hematopoietic cell transplantation in older patients with hematologic malignancies: replacing high-dose cytotoxic therapy with graft-versus tumor effects. Blood 97(11):3390–3400. https://doi.org/10.1182/blood.v97.11.3390

    Article  CAS  PubMed  Google Scholar 

  4. Van Besien K, Artz A, Stock W (2005) Unrelated donor transplantation over the age of 55. Are we merely getting (b) older? Leukemia 19(1):31–33. https://doi.org/10.1038/sj.leu.2403594

    Article  PubMed  Google Scholar 

  5. Lee SJ, Klein J, Haagenson M, Baxter-Lowe LA, Confer DL, Eapen M et al (2007) High resolution donor-recipient HLA matching contributes to the success of unrelated donor marrow transplantation. Blood 110(13):4576–4583. https://doi.org/10.1182/blood-2007-06-097386

    Article  CAS  PubMed  Google Scholar 

  6. D’Souza A, Fretham C, Lee SJ, Arora M, Brunner J, Chhabra S et al (2020) Current use of and trends in hematopoietic cell transplantation in the United States. Biol Blood Marrow Transplant 26(8):e177–e182. https://doi.org/10.1016/j.bbmt.2020.04.013

    Article  PubMed  PubMed Central  Google Scholar 

  7. Wallen H, Gooley TA, Deeg HJ, Pagel JM, Press OW, Appelbaum FR et al (2005) Ablative allogeneic hematopoietic cell transplantation in adults 60 years of age and older. J Clin Oncol 23(15):3439–3446. https://doi.org/10.1200/JCO.2005.05.694

    Article  PubMed  Google Scholar 

  8. Lichtman SM (2006) Therapy insight: therapeutic challenges in the treatment of elderly cancer patients. Nat Clin Pract Oncol 3(2):86–93. https://doi.org/10.1038/ncponc0420

    Article  CAS  PubMed  Google Scholar 

  9. Schetelig J, Bornhäuser M, Schmid C, Hertenstein B, Schwerdtfeger R, Martin H et al (2008) Matched unrelated or matched sibling donors result in comparable survival after allogeneic stem-cell transplantation in elderly patients with acute myeloid leukemia: a report from the cooperative German Transplant Study Group. J Clin Oncol 26(32):5183–5191. https://doi.org/10.1200/JCO.2007.15.5184

    Article  PubMed  Google Scholar 

  10. Lim Z, Brand R, Martino R, van Biezen A, Finke J, Bacigalupo A et al (2010) Allogeneic hematopoietic stem-cell transplantation for patients 50 years or older with myelodysplastic syndromes or secondary acute myeloid leukemia. J Clin Oncol 28(3):405–411. https://doi.org/10.1200/JCO.2009.21.8073

    Article  PubMed  Google Scholar 

  11. McClune BL, Weisdorf DJ, Pedersen TL, Tunes da Silva G, Tallman MS, Sierra J et al (2010) Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome. J Clin Oncol. 28(11):1878–1887. https://doi.org/10.1200/JCO.2009.25.4821

    Article  PubMed  PubMed Central  Google Scholar 

  12. Sorror ML, Sandmaier BM, Storer BE, Franke GN, Laport GG, Chauncey TR et al (2011) Long term outcomes among older patients following nonmyeloablative conditioning and allogeneic hematopoietic cell transplantation for advanced hematologic malignancies. JAMA 306(17):1874–1883. https://doi.org/10.1001/jama.2011.1558

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Chevallier P, Szydlo RM, Blaise D, Tabrizi R, Michallet M, Uzunov M et al (2012) Reduced-intensity conditioning before allogeneic hematopoietic stem cell transplantation in patients over 60 years: a report from the SFGM-TC. Biol Blood Marrow Transplant 18(2):289–294. https://doi.org/10.1016/j.bbmt.2011.07.013

    Article  PubMed  Google Scholar 

  14. Heidenreich S, Ziagkos D, de Wreede LC, van Biezen A, Finke J, Platzbecker U et al (2017) Allogeneic stem cell transplantation for patients age 70 years with myelodysplastic syndrome: a retrospective study of the MDS Subcommittee of the Chronic Malignancies Working Party of the EBMT. Biol Blood Marrow Transplant 23(1):44–52. https://doi.org/10.1016/j.bbmt.2016.09.027

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Ringdén O, Boumendil A, Labopin M, Canaani J, Beelen D, Ehninger G et al (2019) Outcome of allogeneic hematopoietic stem cell transplantation in patients age >69 years with acute myelogenous leukemia: on behalf of the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Biol Blood Marrow Transplant 25:1975–1983. https://doi.org/10.1016/j.bbmt.2019.05.037

    Article  PubMed  Google Scholar 

  17. Hsu J, Chen Z, Shore T, Gergis U, Mayer S, Phillips A et al (2020) Outcomes of allogeneic stem cell transplant for elderly patients with hematologic malignancies. Biol Blood Marrow Transplant 26(4):789–797. https://doi.org/10.1016/j.bbmt.2019.12.766

    Article  CAS  PubMed  Google Scholar 

  18. Bacigalupo A, Ballen K, Rizzo D, Giralt S, Lazarus H, Ho V et al (2009) Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant 15(12):1628–1633. https://doi.org/10.1016/j.bbmt.2009.07.004

    Article  PubMed  PubMed Central  Google Scholar 

  19. Law AD, Salas MQ, Lam W, Michelis FV, Thyagu S, Kim DDH et al (2018) Reduced-intensity conditioning and dual T lymphocyte suppression with antithymocyte globulin and post-transplant cyclophosphamide as graft-versus-host disease prophylaxis in haploidentical hematopoietic stem cell transplants for hematological malignancies. Biol Blood Marrow Transplant 24(11):2259–2264. https://doi.org/10.1016/j.bbmt.2018.07.008

    Article  PubMed  PubMed Central  Google Scholar 

  20. Salas MQ, Atenafu EG, Law AD, Lam W, Pasic I, Chen C, Kim DDH, Michelis FV, Gerbitz A, Lipton JH, Mattsson J, Kumar R, Viswabandya A (2021) Lower dose of ATG combined with post-transplant cyclophosphamide for HLA matched RIC alloHCT is associated with effective control of GVHD and less viral infections. Leuk Lymphoma 62(14):3373–3383

    Article  CAS  PubMed  Google Scholar 

  21. Walker I, Panzarella T, Couban S, Couture F, Devins G, Elemary M, Gallagher G, Kerr H, Kuruvilla J, Lee SJ, Moore J, Nevill T, Popradi G, Roy J, Schultz KR, Szwajcer D, Toze C, Foley R, Cell Therapy Transplant Canada (2020) Addition of anti-thymocyte globulin to standard graft-versus-host disease prophylaxis versus standard treatment alone in patients with haematological malignancies undergoing transplantation from unrelated donors: final analysis of a randomised, open-label, multicentre, phase 3 trial. Lancet Haematol. 7(2):e100–e111

    Article  PubMed  Google Scholar 

  22. Gray RJ (1988) A class of K-sample tests for comparing the cumulative incidence of a competing risk. Ann Stat 16:1141–1154

    Article  Google Scholar 

  23. Fine JP, Gray RJ (1999) A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 94:496–509

    Article  Google Scholar 

  24. Sorror ML, Giralt S, Sandmaier BM, De Lima M, Shahjahan M, Maloney DG et al (2007) Hematopoietic cell transplantation specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiences. Blood 110(13):4606–4613. https://doi.org/10.1182/blood-2007-06-096966

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Fried LP, Bandeen-Roche K, Kasper JD, Guralnik JM (1999) Association of comorbidity with disability in older women: the Women’s Health and Aging Study. J Clin Epidemiol 52(1):27–37. https://doi.org/10.1016/s0895-4356(98)00124-3

    Article  CAS  PubMed  Google Scholar 

  26. Shimoni A, Kröger N, Zabelina T, Ayuk F, Hardan I, Yeshurun M et al (2005) Hematopoietic stem-cell transplantation from unrelated donors in elderly patients (age >55 years) with hematologic malignancies: older age is no longer a contraindication when using reduced intensity conditioning. Leukemia 19(7–12):23. https://doi.org/10.1038/sj.leu.2403591

    Article  Google Scholar 

  27. Wong R, Giralt SA, Martin T, Couriel DR, Anagnostopoulos A, Hosing C et al (2003) Reduced-intensity conditioning for unrelated donor hematopoietic stem cell transplantation as treatment for myeloid malignancies in patients older than 55 years. Blood 102:3052–3059. https://doi.org/10.1182/blood-2003-03-0855

    Article  CAS  PubMed  Google Scholar 

  28. Pohlen M, Groth C, Sauer T, Görlich D, Mesters R, Schliemann C et al (2016) Outcome of allogeneic stem cell transplantation for AML and myelodysplastic syndrome in elderly patients (60 years). Bone Marrow Transplant 51:1441–1448. https://doi.org/10.1038/bmt.2016.156

    Article  CAS  PubMed  Google Scholar 

  29. Koreth J, Aldridge J, Kim HT, Alyea EP 3rd, Cutler C, Armand P et al (2010) Reduced-intensity conditioning hematopoietic stem cell transplantation in patients over 60 years: hematologic malignancy outcomes are not impaired in advanced age. Biol Blood Marrow Transplant 16:792–800. https://doi.org/10.1016/j.bbmt.2011.07.013

    Article  PubMed  PubMed Central  Google Scholar 

  30. Brunner AM, Kim HT, Coughlin E, Alyea EP 3rd, Armand P, Ballen KK et al (2013) Outcomes in patients age 70 or older undergoing allogeneic hematopoietic stem cell transplantation for hematologic malignancies. Biol Blood Marrow Transplant 19:1374–1380. https://doi.org/10.1016/j.bbmt.2013.06.008

    Article  PubMed  Google Scholar 

  31. Alousi AM, Le-Rademacher J, Saliba RM, Appelbaum FR, Artz A, Benjamin J et al (2013) Who is the better donor for older hematopoietic transplant recipients: an older-aged sibling or a young, matched unrelated volunteer? Blood 121:2567–2573. https://doi.org/10.1182/blood-2012-08-453860

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Storb R, Prentice RL, Sullivan KM, Shulman HM, Deeg HJ, Doney KC et al (1983) Predictive factors in chronic graft-versus-host disease in patients with aplastic anemia treated by marrow transplantation from HLA-identical siblings. Ann Intern Med 98:461–466. https://doi.org/10.7326/0003-4819-98-4-461

    Article  CAS  PubMed  Google Scholar 

  33. Ringdén O, Paulin T, Lönnqvist B, Nilsson B (1985) An analysis of factors predisposing to chronic graft-versus-host disease. Exp Hematol 13:1062–1067

    PubMed  Google Scholar 

  34. Salas MQ, Atenafu EG, Bascom O, Wilson L, Lam W, Law AD, Pasic I, Kim DDH, Michelis FV, Al-Shaibani Z, Gerbitz A, Viswabandya A, Lipton JH, Mattsson J, Alibhai SMH, Kumar R (2021) Pilot prospective study of frailty and functionality in routine clinical assessment in allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 56(1):60–69

    Article  CAS  PubMed  Google Scholar 

  35. Salas MQ, Atenafu EG, Pasic I, Al-Shaibani E, Bascom O, Wilson L, Chen C, Law AD, Lam W, Novitzky-Basso I, Kim DDH, Gerbitz A, Viswabandya A, Michelis FV, Lipton JH, Mattsson J, Alibhai S, Kumar R (2022) Impact of hematopoietic cell transplant frailty scale on transplant outcome in adults. Bone Marrow Transplant. https://doi.org/10.1038/s41409-022-01892-3

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Hans Messner Allogeneic Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., Toronto, ON, M5G 2M9, Canada

    Eshrak Al-Shaibani, Carol Chen, Ivan Pasic, Fotios V. Michelis, Wilson Lam, Arjun Law, Igor Novitzky-Basso, Armin Gerbitz, Dennis D. Kim, Auro Viswabandya, Jeffrey H. Lipton, Jonas Mattson & Rajat Kumar

  2. Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada

    Shiyi Chen

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  1. Eshrak Al-Shaibani
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Contributions

Eshrak Al-Shaibani and Rajat Kumar collected the data, interpreted the results, and wrote the paper. Shiyi Chen contributed to the study design and statistical analysis. Carol Chin collected the data. Fotios V. Michelis, Wilson Lam, Arjun Law, Igor Novitzky Basso, Armin Gerbitz, Dennis D. Kim, Auro Viswabandya, Jeffrey H. Lipton, and Jonas Mattson provided the valuable input into the interpretation and reviewed the manuscript.

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Correspondence to Rajat Kumar.

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Highlights

1. HCT appears to be effective and tolerable in selected patients, with comparable OS rate among the three age groups.

2. There is a trend toward longer length of hospitalization during HCT with increasing patient age, and patients aged > 70 years had inferior NRM and EFS compared to younger individuals.

3. There was an association between higher HCT-CI with NRM. Causes for re-admission in the first 6 months were due to infections (71%) and GvHD (16%), and these had significant impact on the outcomes post HCT.

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Al-Shaibani, E., Chen, S., Chen, C. et al. Impact of age on hospitalization and outcomes post allogeneic hematopoietic cell transplantation outcome, a single center experience. Ann Hematol 102, 917–926 (2023). https://doi.org/10.1007/s00277-023-05135-3

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