Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States

Purpose: To evaluate trends and outcomes of allogeneic HCT in adults ≥70 years with hematologic malignancies across the United States (US). Patients and Methods: Adults 70 years and older with a hematologic malignancy undergoing first allogeneic HCT in the US between 2000 and 2013 and reported to the CIBMTR were eligible. Transplant utilization and transplant outcomes including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. Results: Across 103 transplant centers between 2000 and 2013, 1,106 patients ≥70 years underwent HCT. The number and proportion of allografts performed in this population rose markedly over the past decade, accounting for 0.1% of transplants in 2000 to 3.85% (N = 298) in 2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications. Two-year OS and PFS significantly improved over time (OS, 26% [95% CI, 21%-33%] in 2000-2007 to 39% [95% CI, 35%-42%] in 2008-2013, P< 0.001); PFS, 22% [16%-28%] in 2000-2007 to 32% [95% CI, 29%-36%] in 2008-2013, P= 0.003). Two-year transplant-related mortality ranged from 33-35% and was unchanged over time (P=0.54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by hematopoietic cell transplant-comorbidity index ≥3 (HR= 1.27, P= 0.006), umbilical cord blood graft (HR=1.97, P= 0.0002), and myeloablative conditioning (HR=1.61, P=0.0002) as adverse factors. Conclusion: Over the past decade, utilization and survival after allogeneic transplant have increased in patients 70 years and older. Select adults 70 years and older with hematologic malignancies should be considered for transplant.