Universität zu Köln

Sorror, Mohamed L., Sandmaier, Brenda M., Storer, Barry E., Franke, Georg N., Laport, Ginna G., Chauncey, Thomas R., Agura, Edward, Maziarz, Richard T., Langston, Amelia, Hari, Parameswaran ORCID: 0000-0002-8800-297X, Pulsipher, Michael A., Bethge, Wolfgang, Sahebi, Firoozeh, Bruno, Benedetto ORCID: 0000-0002-7299-6770, Maris, Michael B., Yeager, Andrew, Petersen, Finn Bo, Vindelov, Lars, McSweeney, Peter A., Huebel, Kai, Mielcarek, Marco, Georges, George E., Niederwieser, Dietger, Blume, Karl G., Maloney, David G. and Storb, Rainer (2011). Long-term Outcomes Among Older Patients Following Nonmyeloablative Conditioning and Allogeneic Hematopoietic Cell Transplantation for Advanced Hematologic Malignancies. JAMA-J. Am. Med. Assoc., 306 (17). S. 1874 - 1884. CHICAGO: AMER MEDICAL ASSOC. ISSN 1538-3598

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Abstract

Context A minimally toxic nonmyeloablative regimen was developed for allogeneic hematopoietic cell transplantation (HCT) to treat patients with advanced hematologic malignancies who are older or have comorbid conditions. Objective To describe outcomes of patients 60 years or older after receiving minimally toxic nonmyeloablative allogeneic HCT. Design, Setting, and Participants From 1998 to 2008, 372 patients aged 60 to 75 years were enrolled in prospective clinical HCT trials at 18 collaborating institutions using conditioning with low-dose total body irradiation alone or combined with fludarabine, 90 mg/m(2), before related (n=184) or unrelated (n=188) donor transplants. Postgrafting immunosuppression included mycophenolate mofetil and a calcineurin inhibitor. Main Outcome Measures Overall and progression-free survival were estimated by Kaplan-Meier method. Cumulative incidence estimates were calculated for acute and chronic graft-vs-host disease, toxicities, achievement of full donor chimerism, complete remission, relapse, and nonrelapse mortality. Hazard ratios (HRs) were estimated from Cox regression models. Results Overall, 5-year cumulative incidences of nonrelapse mortality and relapse were 27% (95% CI, 22%-32%) and 41% (95% CI, 36%-46%), respectively, leading to 5-year overall and progression-free survival of 35% (95% CI, 30%-40%) and 32% (95% CI, 27%-37%), respectively. These outcomes were not statistically significantly different when stratified by age groups. Furthermore, increasing age was not associated with increases in acute or chronic graft-vs-host disease or organ toxicities. In multivariate models, HCT-specific comorbidity index scores of 1 to 2 (HR, 1.58 [95% CI, 1.08-2.31]) and 3 or greater (HR, 1.97 [95% CI, 1.38-2.80]) were associated with worse survival compared with an HCT-specific comorbidity index score of 0 (P=.003 overall). Similarly, standard relapse risk (HR, 1.67 [95% CI, 1.10-2.54]) and high relapse risk (HR, 2.22 [95% CI, 1.43-3.43]) were associated with worse survival compared with low relapse risk (P<.001 overall). Conclusion Among patients aged 60 to 75 years treated with nonmyeloablative allogeneic HCT, 5-year overall and progression-free survivals were 35% and 32%, respectively. JAMA. 2011; 306(17): 1874-1883

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Sorror, Mohamed L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sandmaier, Brenda M. UNSPECIFIED UNSPECIFIED UNSPECIFIED Storer, Barry E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Franke, Georg N. UNSPECIFIED UNSPECIFIED UNSPECIFIED Laport, Ginna G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Chauncey, Thomas R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Agura, Edward UNSPECIFIED UNSPECIFIED UNSPECIFIED Maziarz, Richard T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Langston, Amelia UNSPECIFIED UNSPECIFIED UNSPECIFIED Hari, Parameswaran UNSPECIFIED orcid.org/0000-0002-8800-297X UNSPECIFIED Pulsipher, Michael A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Bethge, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Sahebi, Firoozeh UNSPECIFIED UNSPECIFIED UNSPECIFIED Bruno, Benedetto UNSPECIFIED orcid.org/0000-0002-7299-6770 UNSPECIFIED Maris, Michael B. UNSPECIFIED UNSPECIFIED UNSPECIFIED Yeager, Andrew UNSPECIFIED UNSPECIFIED UNSPECIFIED Petersen, Finn Bo UNSPECIFIED UNSPECIFIED UNSPECIFIED Vindelov, Lars UNSPECIFIED UNSPECIFIED UNSPECIFIED McSweeney, Peter A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Huebel, Kai UNSPECIFIED UNSPECIFIED UNSPECIFIED Mielcarek, Marco UNSPECIFIED UNSPECIFIED UNSPECIFIED Georges, George E. UNSPECIFIED UNSPECIFIED UNSPECIFIED Niederwieser, Dietger UNSPECIFIED UNSPECIFIED UNSPECIFIED Blume, Karl G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Maloney, David G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Storb, Rainer UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-485582
DOI:	10.1001/jama.2011.1558
Journal or Publication Title:	JAMA-J. Am. Med. Assoc.
Volume:	306
Number:	17
Page Range:	S. 1874 - 1884
Date:	2011
Publisher:	AMER MEDICAL ASSOC
Place of Publication:	CHICAGO
ISSN:	1538-3598
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE MYELOID-LEUKEMIA; VERSUS-HOST-DISEASE; MINIMAL RESIDUAL DISEASE; MARROW TRANSPLANTATION; MYELODYSPLASTIC SYNDROMES; COMORBIDITY INDEX; RISK-ASSESSMENT; FLOW-CYTOMETRY; AGE; METHOTREXATE Multiple languages Medicine, General & Internal Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/48558