Five-year overall, progression-free survival of 35, 32 percent in elderly with blood cancers
TUESDAY, Nov. 1 (HealthDay News) -- For older patients with advanced hematologic malignancies, treatment with minimally toxic nonmyeloablative allogeneic hematopoietic cell transplantation (HCT) is associated with five-year overall and progression-free survival of more than 30 percent, and age does not worsen outcomes, according to a study published in the Nov. 2 issue of the Journal of the American Medical Association.
Mohamed L. Sorror, M.D., from the Fred Hutchinson Cancer Research Center in Seattle, and colleagues investigated the long-term outcomes in 372 patients (aged 60 to 75 years) with advanced hematologic malignancies who underwent nonmyeloablative allogeneic HCT between 1998 to 2008. Before undergoing related and unrelated donor HCT, participants received low-dose total body irradiation either alone or in combination with 90 mg/m² of fludarabine. Overall and progression-free survival were calculated. Cumulative incidence was estimated for achievement of full donor chimerism, toxicities, acute and chronic graft-versus-host disease, relapse, complete remission, and non-relapse mortality.
The investigators found that the five-year cumulative incidences for relapse and non-relapse mortality were 41 and 27 percent, respectively, with overall and progression-free survival of 35 and 32 percent, respectively. The outcomes did not differ significantly upon stratifying by age. Acute or chronic graft-versus-host disease and organ toxicities did not increase with age. On multivariate analysis, patients with HCT-specific comorbidity scores of 1 to 2, and 3 or more had worse survival than those with a score of 0 (hazard ratio [HR], 1.58 and 1.97, respectively). Compared to patients with low-relapse risk, those with standard and high-relapse risks had worse survival (HR, 2.22 and 1.67, respectively).
"Comorbid conditions and risks for disease relapse, but not increasing age, were associated with worse outcomes," the authors write.
Several of the study authors disclosed financial ties with the pharmaceutical and biotechnology industries.
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