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Older Age doesn’t
affect survival after Bone Marrow Transplant
Newswise — Age alone should not determine whether an older
patient with acute myeloid leukemia or
myelodysplastic syndrome receives a blood
stem cell transplant from a matched donor,
researchers of the Center for International
Blood and Marrow Transplant Research
reported at the 50th annual meeting of the
American Society of Hematology.
Patients older than 65 do just as well as younger patients
with transplants that are preceded by a
milder chemotherapy regimen, according to an
intensive analysis of every such transplant
for AML or MDS conducted in North America
between 1995-2005, said senior researcher
Sergio Giralt, M.D., professor in The
University of Texas M. D. Anderson Cancer
Center Department of Stem Cell
Transplantation and Cellular Therapy. The
analysis also included international
transplant data.
The retrospective study of 551 transplants for MDS and 565
for AML showed that age had no statistically
significant impact on transplant-related
mortality, relapse, leukemia-free survival
or overall survival.
“These findings will be important in changing practice for
the treatment of older patients,” Giralt
said. “We also hope the findings persuade
the Centers for Medicaid and Medicare
Services to recommend coverage of this
therapy for MDS patients, as it does now for
AML.”
Findings will be presented at the meeting Monday morning by
Dan McClune, D.O., of the University of
Minnesota Masonic Cancer Center Department
of Leukemia.
Matched donor, or allogenic, blood stem cell transplants
originally were preceded with high-dose
chemotherapy that destroyed the patient’s
blood supply before transplant. For patients
over 65, this “myeloablative” chemotherapy
was too toxic and therefore outcomes were
poor.
Giralt and colleagues at M. D. Anderson pioneered the use
of less-intensive chemotherapy that did not
annihilate a patient’s blood supply. This
“non-myeloablative” preparation opened the
door for older patients to receive the
potentially curative transplants.
Still, some hesitancy has remained even for non-myeloablative
transplants for older patients. Lack of
Medicare coverage also reduces the number of
patients who can receive the treatment,
Giralt said.
The research project divided patients into four age groups:
40 to 54, 55-59, 60-64, and 65-plus. In
addition to finding no statistically
significant difference in survival across
age groups, the researchers found no
difference in acute or chronic graft-vs.-host
disease.
The two most important prognostic variables were disease
type and status of disease at transplant,
which affected survival in the first year,
and affected transplant-related mortality
and relapse in the second year after
transplant.
Giralt and Daniel Weisdorf, M.D., of the School of Medicine
at Washington University, designed and
proposed the research project to the Center
for International Blood and Marrow
Transplant Research. The CIBMTR is a joint
effort of all stem cell transplant centers,
which report their results to the center to
facilitate research such as this study.
Co-authors on the study with McClune, Giralt and Weisdorf
are John DiPersio, M.D., Ph.D. of Princess
Margaret Hospital in Toronto; Armand
Keating, M.D., and Tanya Pederson of the
CIBMTR in Milwaukee; Gisela Tunes da Silva,
Ph.D., of the Medical College of Wisconsin;
J. Sierra, M.D., of the Hospital De Sant Pau
in Barcelona, Spain; and Martin Tallman,
M.D., of the Northwestern University
Feinberg School of Medicine.
The research was funded by the CIBMTR.
About M. D. Anderson
The University of Texas M. D. Anderson
Cancer Center in Houston ranks as one of the
world’s most respected centers focused on
cancer patient care, research, education and
prevention. M. D. Anderson is one of only 41
Comprehensive Cancer Centers designated by
the National Cancer Institute. For six of
the past nine years, M. D. Anderson has
ranked No. 1 in cancer care in “America's
Best Hospitals,” a survey published annually
in U.S. News and World Report.
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