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

Lori Muffly; Marcelo C. Pasquini; Michael Martens; Ruta Brazauskas; Xiaochun Zhu; Kehinde Adekola; Mahmoud Aljurf; Karen K. Ballen; Ashish Bajel; Frederic Baron; Minoo Battiwalla; Amer Beitinjaneh; Jean Yves Cahn; Mathew Carabasi; Yi Bin Chen; Saurabh Chhabra; Stefan Ciurea; Edward Copelan; Anita D’Souza; John Edwards; James Foran; Cesar O. Freytes; Henry C. Fung; Robert Peter Gale; Sergio Giralt; Shahrukh K. Hashmi; Gerhard C. Hildebrandt; Vincent Ho; Ann Jakubowski; Hillard Lazarus; Marlise R. Luskin; Rodrigo Martino; Richard Maziarz; Philip McCarthy; Taiga Nishihori; Rebecca Olin; Richard F. Olsson; Attaphol Pawarode; Edward Peres; Andrew R. Rezvani; David Rizzieri; Bipin N. Savani; Harry C. Schouten; Mitchell Sabloff; Matthew Seftel; Sachiko Seo; Mohamed L. Sorror; Jeff Szer; Baldeep M. Wirk; William A. Wood; Andrew Artz

doi:10.1182/blood-2017-03-772368

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

Lori Muffly, Marcelo C. Pasquini, Michael Martens, Ruta Brazauskas, Xiaochun Zhu, Kehinde Adekola, Mahmoud Aljurf, Karen K. Ballen, Ashish Bajel, Frederic Baron, Minoo Battiwalla, Amer Beitinjaneh, Jean Yves Cahn, Mathew Carabasi, Yi Bin Chen, Saurabh Chhabra, Stefan Ciurea, Edward Copelan, Anita D’Souza, John EdwardsJames Foran, Cesar O. Freytes, Henry C. Fung, Robert Peter Gale, Sergio Giralt, Shahrukh K. Hashmi, Gerhard C. Hildebrandt, Vincent Ho, Ann Jakubowski, Hillard Lazarus, Marlise R. Luskin, Rodrigo Martino, Richard Maziarz, Philip McCarthy, Taiga Nishihori, Rebecca Olin, Richard F. Olsson, Attaphol Pawarode, Edward Peres, Andrew R. Rezvani, David Rizzieri, Bipin N. Savani, Harry C. Schouten, Mitchell Sabloff, Matthew Seftel, Sachiko Seo, Mohamed L. Sorror, Jeff Szer, Baldeep M. Wirk, William A. Wood, Andrew Artz

Research output: Contribution to journal › Article › peer-review

217 Scopus citations

Abstract

In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. 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% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.

Original language	English
Pages (from-to)	1156-1164
Number of pages	9
Journal	Blood
Volume	130
Issue number	9
DOIs	https://doi.org/10.1182/blood-2017-03-772368
State	Published - Aug 31 2017

Bibliographical note

Publisher Copyright:
© 2017, American Society of Hematology. All rights reserved.

Funding

The CIBMTR is supported primarily by National Institutes of Health public health service grant/cooperative agreement 5U24-CA076518 from the National Cancer Institute; the National Heart, Lung, and Blood Institute, and the National Institute of Allergy and Infectious Diseases; grant/cooperative agreement 5U10HL069294 from the National Heart, Lung, and Blood Institute and the National Cancer Institute; contract HHSH250201200016C with Health Resources and Services Administration (US Department of Health and Human Services); grants N00014-15-1-0848 and N00014-16-1-2020 from the Office of Naval Research. This work was also funded by grants from Actinium Pharmaceuticals, Inc.,* Alexion, and Amgen, Inc.*; by an anonymous donation to the Medical College of Wisconsin; by Astellas Pharma US, AstraZeneca, Atara Biotherapeutics, Inc., Be the Match Foundation, Bluebird Bio,

Funders	Funder number
Actinium Pharmaceuticals, Inc.
US Department of Health and Human Services	N00014-15-1-0848, N00014-16-1-2020
National Institutes of Health (NIH)	5U24-CA076518
National Institutes of Health (NIH)
Office of Naval Research Naval Academy
National Heart, Lung, and Blood Institute (NHLBI)	U10HL069294
National Heart, Lung, and Blood Institute (NHLBI)
National Childhood Cancer Registry – National Cancer Institute
National Institute of Allergy and Infectious Diseases	HHSH250201200016C
National Institute of Allergy and Infectious Diseases
Health Resources and Services Administration
AMGen
Astellas Pharma Global Development Incorporated

ASJC Scopus subject areas

Biochemistry
Immunology
Hematology
Cell Biology

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10.1182/blood-2017-03-772368

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Muffly, L., Pasquini, M. C., Martens, M., Brazauskas, R., Zhu, X., Adekola, K., Aljurf, M., Ballen, K. K., Bajel, A., Baron, F., Battiwalla, M., Beitinjaneh, A., Cahn, J. Y., Carabasi, M., Chen, Y. B., Chhabra, S., Ciurea, S., Copelan, E., D’Souza, A., ... Artz, A. (2017). Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States. Blood, 130(9), 1156-1164. https://doi.org/10.1182/blood-2017-03-772368

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

abstract = "In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. 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% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.",

author = "Lori Muffly and Pasquini, {Marcelo C.} and Michael Martens and Ruta Brazauskas and Xiaochun Zhu and Kehinde Adekola and Mahmoud Aljurf and Ballen, {Karen K.} and Ashish Bajel and Frederic Baron and Minoo Battiwalla and Amer Beitinjaneh and Cahn, {Jean Yves} and Mathew Carabasi and Chen, {Yi Bin} and Saurabh Chhabra and Stefan Ciurea and Edward Copelan and Anita D{\textquoteright}Souza and John Edwards and James Foran and Freytes, {Cesar O.} and Fung, {Henry C.} and Gale, {Robert Peter} and Sergio Giralt and Hashmi, {Shahrukh K.} and Hildebrandt, {Gerhard C.} and Vincent Ho and Ann Jakubowski and Hillard Lazarus and Luskin, {Marlise R.} and Rodrigo Martino and Richard Maziarz and Philip McCarthy and Taiga Nishihori and Rebecca Olin and Olsson, {Richard F.} and Attaphol Pawarode and Edward Peres and Rezvani, {Andrew R.} and David Rizzieri and Savani, {Bipin N.} and Schouten, {Harry C.} and Mitchell Sabloff and Matthew Seftel and Sachiko Seo and Sorror, {Mohamed L.} and Jeff Szer and Wirk, {Baldeep M.} and Wood, {William A.} and Andrew Artz",

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doi = "10.1182/blood-2017-03-772368",

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Muffly, L, Pasquini, MC, Martens, M, Brazauskas, R, Zhu, X, Adekola, K, Aljurf, M, Ballen, KK, Bajel, A, Baron, F, Battiwalla, M, Beitinjaneh, A, Cahn, JY, Carabasi, M, Chen, YB, Chhabra, S, Ciurea, S, Copelan, E, D’Souza, A, Edwards, J, Foran, J, Freytes, CO, Fung, HC, Gale, RP, Giralt, S, Hashmi, SK, Hildebrandt, GC, Ho, V, Jakubowski, A, Lazarus, H, Luskin, MR, Martino, R, Maziarz, R, McCarthy, P, Nishihori, T, Olin, R, Olsson, RF, Pawarode, A, Peres, E, Rezvani, AR, Rizzieri, D, Savani, BN, Schouten, HC, Sabloff, M, Seftel, M, Seo, S, Sorror, ML, Szer, J, Wirk, BM, Wood, WA & Artz, A 2017, 'Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States', Blood, vol. 130, no. 9, pp. 1156-1164. https://doi.org/10.1182/blood-2017-03-772368

TY - JOUR

T1 - Increasing use of allogeneic hematopoietic cell transplantation in patients aged 70 years and older in the United States

AU - Muffly, Lori

AU - Pasquini, Marcelo C.

AU - Martens, Michael

AU - Brazauskas, Ruta

AU - Zhu, Xiaochun

AU - Adekola, Kehinde

AU - Aljurf, Mahmoud

AU - Ballen, Karen K.

AU - Bajel, Ashish

AU - Baron, Frederic

AU - Battiwalla, Minoo

AU - Beitinjaneh, Amer

AU - Cahn, Jean Yves

AU - Carabasi, Mathew

AU - Chen, Yi Bin

AU - Chhabra, Saurabh

AU - Ciurea, Stefan

AU - Copelan, Edward

AU - D’Souza, Anita

AU - Edwards, John

AU - Foran, James

AU - Freytes, Cesar O.

AU - Fung, Henry C.

AU - Gale, Robert Peter

AU - Giralt, Sergio

AU - Hashmi, Shahrukh K.

AU - Hildebrandt, Gerhard C.

AU - Ho, Vincent

AU - Jakubowski, Ann

AU - Lazarus, Hillard

AU - Luskin, Marlise R.

AU - Martino, Rodrigo

AU - Maziarz, Richard

AU - McCarthy, Philip

AU - Nishihori, Taiga

AU - Olin, Rebecca

AU - Olsson, Richard F.

AU - Pawarode, Attaphol

AU - Peres, Edward

AU - Rezvani, Andrew R.

AU - Rizzieri, David

AU - Savani, Bipin N.

AU - Schouten, Harry C.

AU - Sabloff, Mitchell

AU - Seftel, Matthew

AU - Seo, Sachiko

AU - Sorror, Mohamed L.

AU - Szer, Jeff

AU - Wirk, Baldeep M.

AU - Wood, William A.

AU - Artz, Andrew

PY - 2017/8/31

Y1 - 2017/8/31

N2 - In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. 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% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.

AB - In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. 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% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.

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

Abstract

Bibliographical note

Funding

ASJC Scopus subject areas

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