Prior autologous stem cell transplant (ASCT), and not traditional prognostic factors, were predictive of graft-versus-host disease-free relapse-free survival (GRFS) in older patients with myeloid malignancies treated with reduced-intensity allogeneic hematopoietic stem cell transplant (HCT), a study has found.1

HCT has a high rate of transplant-related morbidity and mortality, and special considerations should be given prior to offering it to older patients. Investigators sought to confirm that a recently proposed endpoint of GRFS may assist treatment decision-making in older patients with myeloid malignancies by determining the rate of GRFS in older patients undergoing reduced-intensity HCT.

A retrospective analysis on transplant data was conducted on 93 patients older than 60 years diagnosed with acute myeloid leukemia (53 patients), myelodysplastic syndrome (33 patients), and chronic myelomonocytic leukemia (7 patients) who received reduced-intensity HCT between 2000 and 2014.

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A total of 29 patients had a low HCT comorbidity index, 32 had intermediate, and 42 had high risk. Treatments included graft receipt from HLA identical sibling (39 patients), 37 from unmatched unrelated donors, and 17 from mismatched donors). A total of 82 patients received peripheral blood stem cell grafts. All received conditioning regimens, and GVHD prophylaxis. Four patients had previous ASCT.

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Results showed that at 1 year, overall survival was 57%, relapse-free survival was 46%, and GRFS was 25%. At 1 year, GRFS was 26% for patients with acute myeloid leukemia, 27% for those with myelodysplastic syndrome, and 14% for those with chronic myelomonocytic leukemia. Multivariate analysis showed that prior ASCT affected GRFS with a hazard ratio of 3.5 (95% CI, 1.3 – 9.7; P = .02).

“Our findings will assist clinicians in counseling older patients with these diseases about HCT,” the authors concluded. A larger study is needed to further validate their findings.

Reference

  1. Nazha A, Rybicki L, Abounader D, et al. Graft-versus-host disease-free, relapse-free survival (GRFS) after reduced intensity allogeneic hematopoietic stem cell transplant (HCT) in older patients with myeloid malignancies. Poster presented at: BMT Tandem Meetings 2016; February 18-22, 2016; Honolulu, HI.

Topics:

Chronic Myeloid Leukemia Hematologic Cancers