How are the Results of Allogeneic Stem Cell Transplantation in Elderly Patients? A Single-center Experience

INTRODUCTION: In this study, we aimed to present allogeneic hematopoietic stem cell transplantation (allo-HCT) experience in elderly patients with hematological malignancy.
METHODS: Thirty-five patients aged 60 years and older who underwent allo-HSCT between 2017 and 2021 were retrospectively analyzed. Patient's demographic/clinical features, and the outcomes of transplantation were reviewed.
RESULTS: The median age was 63 (range, 60-74) years and 25 (77,1%) were male. Twenty-seven (60%) were diagnosed with AML, followed by MDS (n: 7, 20%). Twenty-three (65,8%) patients had intermediate, and 6 (17,1%) patients had a high hematopoietic cell transplantation-specific comorbidity index score. Karnofsky performance status of ≥ 90% was detected in 15 (42,9%) patients. Busulfan plus fludarabine plus anti-thymocyte globulin was used mainly as a reduced-intensity conditioning regimen, which was used in 18 (51,4%) patients. The median duration of neutrophil and platelet engraftments were 18 (range, 11-27) and 18 (range, 11-33) days, respectively. The median follow-up time was 4 months (range, 0-51), with the OS rate %14,2. The transplant-related mortality rate within the first 30 days after allo-HSCT was detected in 10 patients (28,6%) due to infection and/or GvHD. Response assessment could be performed in 25 (71,4%) patients after transplantation. The duration of PFS was 6 (range, 1-51) months in patients with response evaluation. The rate of PFS was 72% in 1 years and 5 (14,2%) patients were still alive with complete response at the last visit.
DISCUSSION AND CONCLUSION: Reduced-intensity conditioning regimen has provided the important advantage in allo-HSCT, for elderly patients with hematological malignancies such as AML and MDS.

Yaþlý Hastalarada Allojeneik Kök Hücre Nakli Sonuçlarý Nasýl? Tek Merkez Deneyimi

GÝRÝÞ ve AMAÇ: Azaltýlmýþ yoðunluklu hazýrlama (RIC) rejimi, yaþlý hastalarda nakille iliþkili morbidite ve mortalite oranýný azaltmak için allojenik hematopoietik kök hücre naklinde (allo-HCT) önemli faydalar göstermiþtir. Biz de bu çalýþmada 60 yaþ ve üzerindeki hematolojik malignitesi olan hastalarda allo-HSCT deneyimini ve sonuçlarýný sunmayý amaçladýk.

YÖNTEM ve GEREÇLER: 2017-2021 yýllarý arasýnda allo-HSCT uygulanan 60 yaþ ve üstü 35 hasta retrospektif olarak analiz edildi. Hastalarýn nakil anýndaki demografik ve klinik özellikleri ile nakil sonuçlarý incelendi.
BULGULAR: Ortanca yaþ 63 (60-74) ve 25'i (%77,1) erkekti. Yirmi yedi (%60) hasta AML, 20 (%20) hasta MDS tanýlýydý. Yirmi üç (%65,8) hastada orta, 6 (%17,1)’ sonda yüksek hematopoietik hücre transplantasyonu spesifik komorbidite indeks skoru vardý. 15 (%42,9) hastada Karnofsky performans durumu ≥%90 olarak saptandý. Busulfan, fludarabin ve anti-timosit globulin kombinasyonu en sýk kullanýlan RIC rejimiydi ve 18 (%51,4) hastada kullanýldý. Ortanca nötrofil ve trombosit engraftman süresi sýrasýyla 18 (11-27) ve 18 (11-33) gündü. Ortanca takip süresi 4 aydý (aralýk, 0-51), toplam saðkalým oraný %14,2. Allo-HSCT' den sonraki ilk 30 gün içinde transplanta baðlý ölüm oraný enfeksiyon ve/veya GvHD nedeniyle 10 hastada (%28,6) tespit edildi. Nakil sonrasý 25 (%71,4) hastada yanýt deðerlendirmesi yapýlabildi. Yanýt deðerlendirmesi yapýlan hastalarda PFS süresi 6 (daðýlým, 1-51) aydý. PFS oraný 12 ayda %72 idi. Son kontrolde 5 (%14,2) hasta tam yanýtla halen yaþýyordu.
TARTIÞMA ve SONUÇ: Azaltýlmýþ yoðunluklu þartlandýrma rejimi, özellikle AML ve MDS gibi hematolojik maligniteleri olan yaþlý hastalarda allo-HSCT' de önemli bir avantaj saðlamýþtýr.