Citation

Späth C, Busemann C, Krüger WH. J. Cancer Res. Clin. Oncol. 2014; 140(11): 1981-1988.

Copyright

(Copyright © 2014, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00432-014-1748-6

PMID

unavailable

Abstract

INTRODUCTION: Allogeneic stem cell transplantation (alloSCT) has become available for elderly patients or for patients with comorbidities by introduction of reduced-intense conditioning. Comorbidity-related prognosis after alloSCT can be estimated by the hematopoietic cell transplantation comorbidity index (HCT-CI).; Material and Methods: The charts from 85 patients who have undergone 90 alloSCTs between 1999 and 2011 were analysed. Most patients received a dose-reduced conditioning and a graft from an unrelated donor. Patients were stratified for age, HCT-CI, cGvHD versus no cGvHD, and a modified HCT-CI with a further split high-risk score.; Results: Age over 60 years did not affect the outcome. Manifestation of cGvHD improved the prognosis significantly. An additional stratification of the high-risk group of the HCT-CI revealed that even a fraction of these patients can have considerable benefit from an alloSCT. Furthermore, this high-risk collective could be clearly discriminated into two groups with different outcomes.; Conclusions: The investigation confirms that age is no absolute risk factor for alloSCT and demonstrates the heterogeneity of the high-risk group of the HCT-CI. A comprehensive investigation of an additional stratification is suggested. Furthermore, the authors encourage early withdrawal of immunosuppression, even in elderly patients and patients with comorbidities to permit graft-versus-leukaemia/lymphoma, since cGvHD is associated with a significantly better prognosis. © 2014, Springer-Verlag Berlin Heidelberg.

Language: en

Keywords

Humans; Risk Factors; Aged; Female; Male; Middle Aged; adult; human; Severity of Illness Index; suicide; female; male; Comorbidity; aged; Kaplan-Meier Estimate; Elderly; liver failure; mortality; comorbidity; kidney disease; risk factor; pancreatitis; major clinical study; high risk population; middle aged; heart infarction; graft versus host reaction; pathology; cancer patient; lung disease; heart disease; gastrointestinal disease; aciclovir; immunosuppressive treatment; cyclosporin A; immunosuppressive agent; central nervous system disease; mycophenolic acid 2 morpholinoethyl ester; liver disease; metronidazole; Article; methotrexate; outcome assessment; cyclophosphamide; Immunosuppressive Agents; progression free survival; overall survival; Kaplan Meier method; fluconazole; etoposide; itraconazole; hematologic malignancy; herpes simplex; Disease-Free Survival; chronic graft versus host disease; Graft vs Host Disease; lung hemorrhage; mucosal disease; disease free survival; hematopoietic stem cell transplantation; busulfan; allogeneic stem cell transplantation; severity of illness index; Hematopoietic Stem Cell Transplantation; Transplantation, Homologous; Leukemia, Myeloid, Acute; Transplantation Conditioning; cancer prognosis; leukoencephalopathy; acute graft versus host disease; Allogeneic stem cell transplantation; allotransplantation; bladder disease; bronchiolitis obliterans organizing pneumonia; comorbidity assessment; donor lymphocyte infusion; fludarabine; Graft-versus-leukaemia effects; hematopoietic cell transplantation comorbidity index; immunoprophylaxis; infectious complication; melphalan; thiotepa; treosulfan; voriconazole