This retrospective report assessed the outcome of 629 patients aged ≥60 years and who received RIC allo-SCT, with a special emphasis on the comparison of the outcome of patients aged 60-65 and patients aged >65 y. The median age for the whole cohort was 62 (range, 60-71) y. 378 patients (55%) had a myeloid malignancy, while 240 (38%) had lymphoid malignancies, and 11 (2%) had other diseases. 386 patients (61%) received allo-SCT from an HLA-matched related donor, while 199 patients (32%) received the graft from a MUD, and 44 (7%) from mismatched donors. The conditioning regimen consisted of Fludarabine and Busulfan in 280 cases (44.5%), Fludarabine and low dose TBI in 150 cases (24%). The remaining 199 patients (32%) received other so-called RIC regimens. With a median follow-up of 9 (range, 1-90) m., grade II-IV and grade III-IV acute GVHD occurred in 29% (n=182) and 12% (n=76) of patients, respectively. Chronic GVHD was observed in 145 patients (23%; limited: n=67; extensive: n=72; unknown stage: n=6). 180 patients died of transplant-related causes (TRM: 29%). The estimates of overall survival (OS) at 1 and 2 years were 57% (95%CI, 53-62%) and 47% (95%CI, 42-52%), respectively. In order to assess the applicability of RIC allo-SCT to the older age group, we compared the outcome of patients aged from 60 to 65 y. (n=516) and those aged >65 y. (n=113). Except for age, in univariate analysis, these 2 groups were not statistically different in terms of demographic, disease or transplant characteristics. The incidences of grade II-IV and grade III-IV acute GVHD were comparable between both groups (29% vs. 30%, p=NS; and 12% vs. 12%; p=NS). The TRM incidence was 29% in the younger group vs. 27% in the older group (p=NS). The estimates of OS at one and 2 years were 58% (95%CI, 53-62%) and 47% (95%CI, 42-52%) in the younger age group and 55% (95%CI, 44-65%) and 48% (95%CI, 37-60%) in the older age group (p=NS). In a Cox multivariate analysis accounting for all relevant factors, age >65 y. was not found to be a statistically significant factor associated with worsened survival. In all, this data support the use of RIC-allo-SCT in patients >60 y. Outcome of patients aged >65 y. appears to be comparable to that of patients aged 60-65 y. Physiologic aging is likely more important than chronologic aging. With the refinement of comorbidities scoring systems, age per se (at least up to 70 y.) should not be a contraindication to perform RIC allo-SCT.
Twenty-two patients (mean age 41 years) in blast crisis or accelerated phase (AP) of chronic myelogenous leukemia (CML) were treated with cytosine arabinoside (Ara-C) 500 mg/m2 [intermediate dose] or 1000 mg/m2 [high dose] twice a day for 6 days and amsacrine (AMSA) 120 mg/m2 for 3 days. Twenty-one cases were of myeloid type and one was a lymphoid BC. The mean duration of aplasia (neutrophils < 0.5 × 109/1) was 21.5 days. Four patients (18%) died of infection during aplasia and minor toxicities were noted for the remainders. Nine patients (41%) achieved a complete remission (CR) and 4 (18%) a partial response. Various additional therapies were proposed after induction treatment including allogeneic bone marrow transplantation (2 patients), Ara-C and AMSA maintenance or other regimens with or without alpha-interferon (9 patients). Median survival for the entire cohort was 20 weeks (wks), significantly superior for complete responders (37 wks) than for others (7 wks) (p = 0.008). In this study, age, sex, initial platelet or basophil counts, interval between diagnosis of CML and blast crisis were not predictive of response. Although inducing a high CR rate and associated with acceptable toxicity, this regimen did not improve the survival of patients with BC of CML, strengthening the need for alternate approaches to be defined.
