Allogeneic stem cell transplant (AHCT) in the eighth decade: Age is just a number.

Abstract

7045 Background: Allogeneic hematopoietic cell transplant (AHCT) is a curative treatment for hematological malignancies but older adults ( > 70 years) have been historically excluded due to age-related comorbidities and concern for increased non-relapse mortality (NRM). Reduced intensity conditioning (RIC) regimens, and improvements in supportive measures have broadened AHCT to older adults. Limited data exist regarding AHCT in their eighth decade ( > 70). Methods: We evaluated 24 consecutive pts aged > 70 years receiving AHCT for various hematological malignancies between 2012 and 2016 at the Medical College of Wisconsin. Results: Median age was 72 (range, 70-76), and 62% were male. Disease indications included 11 AML, 6 CMML, 1 MDS, 1 NHL, 1 MM with only 11 patients (46%) in CR at transplant. 15 patients (62%) had normal karyotype, while other 9 had complex karyotype (n = 4), trisomy 11 (n = 1), trisomy 8 (n = 1). 6 patients (26%) had low-risk DRI score, 9 (39%) intermediate and 8 (35%) had high-risk score. Median HCT-CI score was 1.5 (range, 0-5) and 79% patients had a score of ≤2. Donors were related in 50% cases (3 haploidentical, 7 matched siblings and 2 syngeneic). Conditioning was RIC in 23 pts and all peripheral blood grafts. Median follow up was 14.2 months (range, 1.5-42.3). At day 28, 92% had neutrophil engraftment and 87% platelet engraftment. 2 patients had primary graft failure. 4 patients had acute GVHD, 4 had chronic GVHD,1 had both. Median CD3 chimerism was 99% (range, 74-100), CD33 was 100% (range, 78-100). Median of hospital-free days in the first 100 days was 80 and 160 days in the first 6 months after AHCT. 4 pts (17%) underwent AHCT entirely in outpatient setting. 6 patients relapsed at a median of 145 days (range 40-195). Survival at 2 years was 67% with relapse-free survival of 56% and NRM of 14%. Causes of death included sepsis (n = 1), fungal pneumonia (n = 1), cardiac (1), IPS (1), relapse (3). Conclusions: This experience with septuagenarians undergoing AHCT demonstrated an excellent 2 yr survival of 67% and that they can receive AHCT in the outpatient setting with a median hospital-free period of 80 days within the first 100 days. In carefully selected patients NRM with AHCT is manageable. Age alone should not determine eligibility for AHCT.