Universität zu Köln

Rice, Carmel, Eikema, Dirk-Jan, Marsh, Judith C. W., Knol, Cora, Hebert, Kyle, Putter, Hein ORCID: 0000-0001-5395-1422, Peterson, Eefke, Deeg, H. Joachim, Halkes, Stijn, Pidala, Joseph, Anderlini, Paolo, Tischer, Johanna, Kroger, Nicolaus, McDonald, Andrew, Antin, Joseph H., Schaap, Nicolaas P., Hallek, Michael, Einsele, Herman, Mathews, Vikram, Kapoor, Neena, Boelens, Jaap-Jan, Mufti, Ghulam J., Potter, Victoria, de la Tour, Regis Pefault, Eapen, Mary and Dufour, Carlo (2019). Allogeneic Hematopoietic Cell Transplantation in Patients Aged 50 Years or Older with Severe Aplastic Anemia. Biol. Blood Marrow Transplant., 25 (3). S. 488 - 496. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1523-6536

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Abstract

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.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Rice, Carmel UNSPECIFIED UNSPECIFIED UNSPECIFIED Eikema, Dirk-Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Marsh, Judith C. W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Knol, Cora UNSPECIFIED UNSPECIFIED UNSPECIFIED Hebert, Kyle UNSPECIFIED UNSPECIFIED UNSPECIFIED Putter, Hein UNSPECIFIED orcid.org/0000-0001-5395-1422 UNSPECIFIED Peterson, Eefke UNSPECIFIED UNSPECIFIED UNSPECIFIED Deeg, H. Joachim UNSPECIFIED UNSPECIFIED UNSPECIFIED Halkes, Stijn UNSPECIFIED UNSPECIFIED UNSPECIFIED Pidala, Joseph UNSPECIFIED UNSPECIFIED UNSPECIFIED Anderlini, Paolo UNSPECIFIED UNSPECIFIED UNSPECIFIED Tischer, Johanna UNSPECIFIED UNSPECIFIED UNSPECIFIED Kroger, Nicolaus UNSPECIFIED UNSPECIFIED UNSPECIFIED McDonald, Andrew UNSPECIFIED UNSPECIFIED UNSPECIFIED Antin, Joseph H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaap, Nicolaas P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Hallek, Michael UNSPECIFIED UNSPECIFIED UNSPECIFIED Einsele, Herman UNSPECIFIED UNSPECIFIED UNSPECIFIED Mathews, Vikram UNSPECIFIED UNSPECIFIED UNSPECIFIED Kapoor, Neena UNSPECIFIED UNSPECIFIED UNSPECIFIED Boelens, Jaap-Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Mufti, Ghulam J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Potter, Victoria UNSPECIFIED UNSPECIFIED UNSPECIFIED de la Tour, Regis Pefault UNSPECIFIED UNSPECIFIED UNSPECIFIED Eapen, Mary UNSPECIFIED UNSPECIFIED UNSPECIFIED Dufour, Carlo UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-154584
DOI:	10.1016/j.bbmt.2018.08.029
Journal or Publication Title:	Biol. Blood Marrow Transplant.
Volume:	25
Number:	3
Page Range:	S. 488 - 496
Date:	2019
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1523-6536
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ANTITHYMOCYTE GLOBULIN; CLONAL HEMATOPOIESIS; MYELODYSPLASTIC SYNDROME; COMPARING CYCLOSPORINE; SOMATIC MUTATIONS; ALEMTUZUMAB; OUTCOMES; BLOOD; MALIGNANCIES; MULTICENTER Multiple languages Hematology; Immunology; Transplantation Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15458