Does younger donor age affect the outcome of reduced-intensity allogeneic hematopoietic stem cell transplantation for hematologic malignancies beneficially?

• Published in: Bone marrow transplantation (Basingstoke) Vol. 38; no. 2; pp. 95 - 100
• Main Authors: MEHTA, J, GORDON, L. I, SINGHAL, S, TALLMAN, M. S, WINTER, J. N, EVENS, A. O, FRANKFURT, O, WILLIAMS, S. F, GRINBLATT, D, KAMINER, L, MEAGHER, R
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.07.2006
• Subjects: Adult; Age; Age Factors; Aged; Alleles; Analysis of Variance; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antigens; Biological and medical sciences; Blood cancer; Bone marrow; Bone marrow, stem cells transplantation. Graft versus host reaction; Cyclophosphamide; Cyclosporins; Disease-Free Survival; Donors; Dosage and administration; Female; Graft Survival; Graft vs Host Disease - complications; Graft-versus-host reaction; Health aspects; Hematologic Neoplasms - therapy; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic stem cells; Histocompatibility antigen HLA; Humans; L-Lactate dehydrogenase; Lactate dehydrogenase; Lactic acid; Male; Medical sciences; Melphalan; Middle Aged; Mycophenolate mofetil; Mycophenolic acid; Patients; Recurrence; Retrospective Studies; Risk Factors; Siblings; Stem cell transplantation; Stem cells; Survival; Survival Rate; Tacrolimus; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Homologous; Treatment Outcome; United States; Human; Relapse; Prognosis; Hematology; Stem cell; Hematopoietic cell; Homograft; Malignant hemopathy; Non myeloablative treatment; allograft; Donor; Graft; Age
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1705388

Sixty three patients aged 27-66 years (median 52) were allografted from HLA-matched sibling (n=47), 10 of 10 allele-matched unrelated (n=19), or one-antigen/allele-mismatched (n=7) donors aged 24-69 years (median 46) after a conditioning regimen comprising 100 mg/m(2) melphalan. Cyclophosphamide (50 mg/kg) was also administered to patients who had not been autografted previously. Cyclosporine or tacrolimus, and mycophenolate mofetil were administered to prevent graft-versus-host disease (GVHD). The 2-year cumulative incidences of relapse and TRM were 55 and 24% respectively, and 2-year probabilities of overall survival (OS) and disease-free survival (DFS) were 36 and 21%, respectively. Poor performance status, donor age >45 years and elevated lactate dehydrogenase (LDH) increased the risk of treatment-related mortality (TRM), refractory disease and donor age >45 years increased the risk of relapse, and OS and DFS were adversely influenced by refractory disease, poor performance status, increased LDH, and donor age >45 years. Our data suggest that younger donor age is associated with better outcome after sub-myeloablative allogeneic hematopoietic stem cell transplantation (HSCT) for hematologic malignancies due to lower TRM and relapse. This finding raises the question of whether a young 10-allele-matched unrelated donor is superior to an older matched sibling donor in patients where the clinical situation permits a choice between such donors.