Blood cancers

No evidence to exclude elderly from autoHCT

A European study reviewing more than 21,000 autologous hematopoietic cell transplantations has confirmed that old age is not a barrier to successful outcomes.

The cases reported to the European Society for Blood and Marrow Transplantation (EBMT) between 2000 and 2014 of patients aged 65-89 years included diagnoses such as multiple myeloma, lymphoproliferative disorders and acute leukaemia.

Younger patients (65-69 year olds) had better outcomes than an older group from 70 years, but non-relapse mortality and overall survival in both groups were considered acceptable. The incidence of transplant complications did not differ between the age groups.

The study concluded ‘our data in a large cohort of such patients convincingly suggest that age per se should not be an exclusion criteria to consider autoHCT in this population’.

Commenting on the study Professor Jeff Szer, director of the Western and Central Melbourne Integrated Cancer Service and president of the Worldwide Network for Blood and Marrow Transplantation, said semi-arbitrary age limits were often used on the introduction of each new technology.

However better environmental control around transplants had improved outcomes dramatically and reduced intensity conditioning had expanded the patient population considered suitable for transplants.

“The trend over the last 35 years has been to progressively increase the upper age in all transplant groups. But the overriding issue is that we understand chronological age is not the predictive factor in non-relapse mortality.”

He said increasing use of measures such as the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) provided more relevant information on risk.

“Age is included in the HCT-CI but it is a minor factor in this score.”

He said given bone marrow reserves decreased over time, age played more of a role in the pre-transplant stage and the ability to collect adequate numbers of cells.

The study found an overall survival of 87% at one year and 67.7% at three years. Survival increased with more recent year of transplantation.

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