TY - JOUR
T1 - Haploidentical transplantation using posttransplant cyclophosphamide as GVHD prophylaxis in patients over age 70
AU - Imus, Philip H.
AU - Tsai, Hua Ling
AU - Luznik, Leo
AU - Fuchs, Ephraim J.
AU - Huff, Carol Ann
AU - Gladstone, Douglas E.
AU - Lowery, Patrick
AU - Ambinder, Richard F.
AU - Borrello, Ivan M.
AU - Swinnen, Lode J.
AU - Wagner-Johnston, Nina
AU - Gocke, Christian B.
AU - Abbas Ali, Syed
AU - Bolaños-Meade, F. Javier
AU - Varadhan, Ravi
AU - Jones, Richard J.
N1 - Publisher Copyright:
© 2019 by The American Society of Hematology.
PY - 2019/9/10
Y1 - 2019/9/10
N2 - Hematologic malignancies in older people are unlikely to be cured with chemotherapy alone. Advances in allogeneic blood or marrow transplantation (alloBMT), especially nonmyeloablative (NMA) conditioning and the use of haploidentical donors, now make this therapy available to older people; however, long-term outcomes and predictors of success are unclear. We reviewed the outcomes of 93 consecutive patients aged 70 and older (median, 72; range, 70-78), who underwent haploidentical BMT at Johns Hopkins Hospital between 1 September 2009 and 1 April 2018. All patients received NMA conditioning and posttransplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis. The 2-year overall survival was 53%, and 2-year event-free survival was 43%. The 180-day cumulative incidence (CuI) of nonrelapse mortality (NRM) was 14%, and the 2-year CuI was 27%. The 2-year CuI of relapse was 30%. Of 78 patients who were alive and had their weight recorded on day 180, weight loss predicted subsequent NRM (subdistribution hazard ratio, 1.0; 95% CI, 1-1.13; P 5 .048). In conclusion, haploidentical BMT with PTCy is feasible and relatively safe in septuagenarians. Although early, 6-month NRM was relatively low at 14%, but overall NRM continued to climb to 27% at 2 years, at least in part because of late deaths that appeared to be somewhat age related. Further studies to elucidate predictors of NRM are warranted.
AB - Hematologic malignancies in older people are unlikely to be cured with chemotherapy alone. Advances in allogeneic blood or marrow transplantation (alloBMT), especially nonmyeloablative (NMA) conditioning and the use of haploidentical donors, now make this therapy available to older people; however, long-term outcomes and predictors of success are unclear. We reviewed the outcomes of 93 consecutive patients aged 70 and older (median, 72; range, 70-78), who underwent haploidentical BMT at Johns Hopkins Hospital between 1 September 2009 and 1 April 2018. All patients received NMA conditioning and posttransplantation cyclophosphamide (PTCy) as graft-versus-host disease (GVHD) prophylaxis. The 2-year overall survival was 53%, and 2-year event-free survival was 43%. The 180-day cumulative incidence (CuI) of nonrelapse mortality (NRM) was 14%, and the 2-year CuI was 27%. The 2-year CuI of relapse was 30%. Of 78 patients who were alive and had their weight recorded on day 180, weight loss predicted subsequent NRM (subdistribution hazard ratio, 1.0; 95% CI, 1-1.13; P 5 .048). In conclusion, haploidentical BMT with PTCy is feasible and relatively safe in septuagenarians. Although early, 6-month NRM was relatively low at 14%, but overall NRM continued to climb to 27% at 2 years, at least in part because of late deaths that appeared to be somewhat age related. Further studies to elucidate predictors of NRM are warranted.
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U2 - 10.1182/bloodadvances.2019000155
DO - 10.1182/bloodadvances.2019000155
M3 - Article
C2 - 31492679
AN - SCOPUS:85072217458
SN - 2473-9529
VL - 3
SP - 2608
EP - 2616
JO - Blood Advances
JF - Blood Advances
IS - 17
ER -