Faculty Collaboration Database

Impact of pre-transplant co-morbidities on outcome after alemtuzumab-based reduced intensity conditioning allo-SCT in elderly patients: a British Society of Blood and Marrow Transplantation study. Bone Marrow Transplant 2015 Jan;50(1):82-6

Date

10/07/2014

Pubmed ID

25285801

DOI

10.1038/bmt.2014.215

Scopus ID

2-s2.0-84920665681 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

The advent of reduced intensity conditioning (RIC) regimens has permitted the extension of allo-SCT to selected patients into their eighth decade but GVHD remains a major cause of morbidity and mortality. Alemtuzumab is increasingly used to reduce the risk of severe GVHD, but there are concerns that T-cell depletion may compromise outcome particularly in older patients. We therefore studied the impact of pre-transplant factors on the outcome of 187 patients with a haematological malignancy over the age of 60 transplanted using an alemtuzumab-based RIC regimen of whom co-morbidity scoring was possible in 169. Of the patients, 120 had a haematopoietic cell transplantation co-morbidity index (HCT-CI) of 0 or 1 and 49 had a score of 2 or more. The 5-year OS was 33%. In multivariable analysis, OS was determined by co-morbidity score (P=0.001) and disease status at transplant (P=0.004) but not by patient age. Non-relapse mortality was determined by co-morbidity score (P=0.001). Two-year OS for patients with a HCT-CI of 0-1 was 59 versus 6% for patients with a higher score. Alemtuzumab-based RIC allografts can be delivered safely in patients aged over 60 but co-morbidity scoring is mandatory to identify patients who will benefit.

Author List

Nikolousis E, Nagra S, Pearce R, Perry J, Kirkland K, Byrne J, Dignan F, Tholouli E, Gilleece M, Russell N, Littlewood T, Cook M, Peniket A, Shaw BE, Cook G, Craddock C

Author

Bronwen E. Shaw MBChB, PhD Center Director, Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Alemtuzumab
Allografts
Antibodies, Monoclonal, Humanized
Antineoplastic Agents
Female
Hematologic Neoplasms
Hematopoietic Stem Cell Transplantation
Humans
Lymphocyte Depletion
Male
Middle Aged
Retrospective Studies
Societies, Medical
Survival Rate
Transplantation Conditioning
United Kingdom