Transplantation In Elderly Patients Research Articles

Pretransplantation Inflammatory and Nutritional Status in Elderly Allogeneic Hematopoietic Stem Cell Transplantation: Prognostic Value of C-Reactive Protein-to-Albumin Ratio

There are no clear criteria for selecting elderly patients with hematologic malignancies eligible for allogeneic hematopoietic stem cell transplantation (HSCT). This study aimed to evaluate inflammatory and nutritional status biomarkers as prognostic indicators of allogeneic HSCT in elderly patients. We compared the prognostic effects of 4 representative pretransplantation biomarkers: C-reactive protein-to-albumin ratio (CAR), Glasgow Prognostic Score (GPS), prognostic nutritional index (PNI), and albumin-to-globulin ratio (AGR). A total of 143 patients age ≥60 years who underwent their first allogeneic HSCT for a hematologic malignancy were enrolled between 2010 and 2020 in our single-center cohort. The median patient age was 65 years (range, 60 to 72 years). Pretransplantation high CAR, high GPS, and low PNI scores were associated with poor overall survival (OS), but the AGR was not associated with OS. Among the 4 biomarkers, CAR stratified OS most significantly (P < .001). Multivariate analyses identified only high CAR as an independent prognostic factor associated with OS (hazard ratio [HR], 1.98; P = .031) and showed that a Hematopoietic Cell Transplantation-Specific Comorbidity Index (HCT-CI) score ≥3 also was associated with OS (HR, 2.04; P = .012). High CAR was correlated with poor performance status, male sex, and high Disease Risk Index, but not with high HCT-CI score. When the patients were stratified into 3 groups according to a composite risk assessment using CAR and HCT-CI, the 3-year OS decreased significantly with increasing scores (82.8%, 50.3%, and 27.0%, respectively; P < .0001). In conclusion, CAR is the most useful prognostic indicator among the inflammatory and nutritional status biomarkers for allogeneic HSCT in elderly patients. Inflammatory and nutritional status in the elderly may be important prognostic factors for allogeneic HSCT independent of HCT-CI score.

Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients: The Experience of the Spanish Group of Hematopoietic Transplantation and Cell Therapy (GETH-TC)

Introduction Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is associated with significant toxicity and high risk of related mortality in older patients, especially when myeloablative conditioning is used. However, the upper limit of age for this procedure is not clearly defined. The aim of the study is to evaluate the safety and effectiveness of allo-HSCT in a cohort of elderly patients transplanted in Spain, considering non-relapse mortality (NRM), cumulative incidence (CI) of relapse, overall survival (OS) and progression-free survival (PFS). As secondary objectives, we evaluate the potential toxicity of allo-HSCT analyzing the days from infusion to hospital discharge, the number of readmissions within the first year, the CI of graft-versus-host disease (GvHD) and GVHD-free/relapse-free survival (GRFS). Finally, we also looked for prognostic factors significantly impacting OS. Methods We retrospectively analyzed 529 patients ≥65 years of age undergoing a first allo-HSCT between 2011 and 2020 in 17 Spanish centres, regardless of the indication and characteristics of transplantation. Subanalyses were performed according to chronological age (65-69 vs ≥70 years of age) and conditioning intensity (myeloablative vs non-myeloablative). Results Median age was 67.2 years (range 65.0-82.5) and 54 patients were ≥70 years. The most frequent indication was acute leukemia in 260 patients (49.1%). Clinical characteristics are shown in Table 1. Patients ≥70 years were more frequently male and had a lower HCT-CI than patients &amp;lt;70, without any other differences in patients' or transplant characteristics. The median follow-up was 51.2 months (range 9.3-139.6). At 1- and 4-years post-transplant, NRM were 24.3% (95%CI 21-28) and 32.0% (95%CI 28-36), CI of relapse were 21.4% (95%CI 18-25) and 29.1% (95%CI 25-33), OS were 61.2% (95%CI 57-65) and 43.4% (95%CI 39-48) and PFS were 54.3% (95%CI 50-58) and 38.9% (95%CI 35-43), respectively (Figure 1). No differences were found according to age group 65-69 vs ≥70 ( p=0.822, p=0.835, p=0.648 and p=0.743, respectively). Patients who had received myeloablative conditioning had lower CI of relapse (at 4 years post-transplant 19.3% vs. 30.7%, p=0.030), with no differences in NRM ( p=0.308), OS ( p=0.440) or PFS ( p=0.261). Regarding the duration of allo-HSCT admission, 486 patients were discharged alive, with a median number of hospital days from infusion to discharge of 22 (range 8-142). There were no differences based on age group ( p=0.635) or conditioning intensity ( p=0.606). Among 486 patients who were primary discharged, 320 (66.0%) needed a new readmission during the first-year post-transplant, with a median of 1 (range 0-6) up to day +100 and 2 (range 1-10) up to day +365. There were also no differences according to age ( p=0.789 and p=0.779, respectively) or conditioning intensity ( p=0.264 and p=0.818, espectively). Acute GvHD occurred in 265 patients (58.2%), 205 (45.1%) grades I-II and 60 (13.2%) grades III-IV. The CI of acute GvHD grades II-IV and grades III-IV at day +100 was 43.5% and 16.9%, respectively. A total of 174 patients (38.2%) developed chronic GvHD, 66 (14.6%) mild, 49 (10.8%) moderate and 56 (12.4%) severe. The CI of moderate-severe chronic GvHD at 1 and 2 years was 18.2% and 22.4%, respectively. According to age group, there were no differences in the CI of acute GvHD grades II-IV ( p=0.920), acute GvHD grades III-IV ( p=0.853) or chronic moderate-severe GvHD ( p=0.798). At 1- and 4-years after allo-HSCT, GRFS were 37.6% (95%CI 33-42) and 23.7% (95%CI 20-28), with no differences by age group ( p=0.569) or conditioning intensity ( p=0.707). In multivariate analysis, ECOG pretransplant ≥1 (HR 1.32, 95%CI 1-1.7; p=0.028), HCT-CI ≥3 (HR 1.34, 95%CI 1.1-1.7; p=0.016), high/very high DRI (HR 1.62, 95%CI 1.3-2.1; p&amp;lt;0.001) and no development of chronic GvHD (HR 2.99, 95%CI 2.3-3.9; p&amp;lt;0.001) were associated with worse OS. Age, gender, previous lines of treatment or autologous HSCT, donor type, stem cell source, conditioning intensity and development of acute GvHD did not influence OS. Conclusions Allo-HSCT is effective and safe at ages over 65 years, or even 70 years old. Myeloablative conditioning regimen may offer a lower risk of relapse without increasing toxicity. In our experience, ECOG, HCT-CI, DRI and chronic GvHD are more relevant parameters for post-transplant survival than chronological age.

Oral Abstract: AML-112 Impact of Consolidation Chemotherapy Intensity Before Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients With Acute Myeloid Leukemia

Oral Abstract: AML-112 Impact of Consolidation Chemotherapy Intensity Before Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients With Acute Myeloid Leukemia

AML-112 Impact of Consolidation Chemotherapy Intensity Before Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients With Acute Myeloid Leukemia

AML-112 Impact of Consolidation Chemotherapy Intensity Before Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients With Acute Myeloid Leukemia

POSTER: AML-112 Impact of Consolidation Chemotherapy Intensity Before Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients With Acute Myeloid Leukemia

POSTER: AML-112 Impact of Consolidation Chemotherapy Intensity Before Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients With Acute Myeloid Leukemia

KIDNEY TRANSPLANTATION IN AN AGED PATIENT WITH MULTIPLE COMORBIDITIES: A REVIEW BASED ON UNUSUAL CLINICAL CASE

The article raises a question about the possible and effective kidney transplantation in elderly patients with various severe comorbidities. The analysis is based on an example of successful kidney transplantation from a deceased donor when a 67-year-old patient had severe concomitant background: obesity, diabetes mellitus, and cardiovascular disturbances. Despite unfavorable prognosis and further unpredictable illnesses such as COVID-19, candidal esophagitis, coronary attack, and pneumonia, the patient has not develop graft injury or rejection and kept sufficient kidney function.&#x0D; The research was mainly focused on coexisting illnesses and their influence on kidney transplantation consequences. Following disease groups were discussed regarding their impact on transplantation outcomes and prognosis: arterial hypertension, cardiac disorders, diabetes mellitus, and obesity. Patient’s age, previous interventions, and comorbidities were observed for association with outcomes and risk of graft rejection. A review of available publications compared approaches for recipient selection in different clinical centers as well.

Clinical Experience of Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients Aged 60 Years and Older in South Korea.

The purpose of this study is to share our outcomes and experiences on allogeneic hematopoietic stem cell transplantation (HSCT) in elderly patients aged 60 years and older with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) in South Korea, and to compare them with other studies. We analyzed the clinical outcomes of 116 patients with AML or MDS aged 60 years and older who underwent allogeneic HSCT. We also analyzed which pretreatment factors affect the overall survival (OS) after allogeneic HSCT. Neutrophil and platelet engraftment were achieved at median day +11 [interquartile range (IQR) 10-15] and +14 (IQR 11-19), respectively. A complete donor chimerism was confirmed in 65 (56.0%) patients at 3 weeks and in 63 (54.3%) patients at 3 months after HSCT. The estimated incidence of grade II-IV acute graft-versus-host disease (GVHD) at day 100 was 13.7%. The estimated incidence of chronic GVHD at 2 years was 38.8%. Within a median follow-up of 14 months after HSCT, OS was 64% at 1 year and 55% at 2 years, and non-relapse mortality (NRM) was 20% at 1 year and 28% at 2 years. Multivariate analysis revealed that male sex and Hematopoietic Cell Transplantation-Specific Comorbidity Index ≥3 were associated with poor OS. This study showed that allogeneic HSCT in elderly adults aged 60 and older can be performed with successful engraftment and acceptable NRM and OS are expected given the generally known survival of patients with higher risk MDS and poor risk AML.

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

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

Validating the G8 screening tool for determining the need for hematopoietic stem cell transplantation in elderly patients

近年，骨髄非破壊的前処置の普及，支持療法の向上により高齢者に対する同種幹細胞移植が増えている。しかし，その適応を客観的に判断するのは難しく，多くは主治医の経験的判断に委ねられている。今回，高齢者に対する移植適応の判断材料として，高齢者機能評価スクリーニングツールのG8 screening Toolが有用か，当院の症例を用いて後方視的に検討した。2011年1月から2021年12月に初回の同種幹細胞移植を受けた65歳以上の54例を対象とし，G8 screening Toolのスコアと退院時の生死との関連性を検討した。スコアは生存退院群と死亡退院群の間で有意差を認めた。また，ROC曲線から得られたcut off値10.0以上の群，未満の群で検討したところ，生存率に有意差を認めた。G8 screening Toolのスコアは高齢者に対する移植の可否の判断に有用であり，予後予測にも利用できると考える。

Renal Replacement Therapy For Elderly Patients with ESKD Through Shared Decision-Making.

The incidence and prevalence of end-stage kidney disease (ESKD) in Korea are increasing, and ESKD constitutes a very important medical and social issue. Elderly dialysis patients have the highest risk of early mortality within 3 months after initiating dialysis, and geriatric syndromes such as aging, frailty, functional impairment, and cognitive impairment are crucial for the prognosis of elderly patients. Shared decision-making (SDM) is an approach through which clinicians and patients can achieve informed preferences, thereby yielding better clinical outcomes and quality of life. Through SDM-based, close consultation among patients, families, and healthcare providers, an ESKD Life-Plan for elderly patients should be established. A multidisciplinary approach led by nephrologists can help them to provide proper vascular access for dialysis at the right time, with the right evidence, and to the right patient. Strategies that can improve peritoneal dialysis in elderly patients include assisted peritoneal dialysis, homecare support programs, and automated peritoneal dialysis. In order to enhance the role of kidney transplantation in elderly patients with ESKD, it is necessary to accurately identify patients' clinical conditions before transplantation and to perform active rehabilitation activities and postoperative management to promote recovery after transplantation. With the aging population and the increase in ESKD in the elderly, clinicians must identify factors affecting the mortality and quality of life of elderly dialysis patients.

P8.125: Anti-thymocyte Globulin Versus Basiliximab Induction For Kidney Transplantation in Elderly Patients: Matched Analysis With Korean Multicentric Registry

Introduction: Basiliximab (BSX) and anti-thymocyte globulins (ATG), are two major immunosuppressive agents commonly used as induction therapy for kidney transplant (KT) recipients. The superiority of ATG over BSX has not been well established especially in elderly KT recipients with low immunological risk. Method: A total of 847 elderly (≥60 years) low-risk KT patients in the Korean Organ Transplantation Registry were matched with 2:1 propensity scores and compared according to the ATG and BSX induction therapy. The primary outcome was patient and graft survival. The secondary outcome was biopsy-proven rejection, graft function, BK virus nephropathy, infection, cancer, new-onset diabetes mellitus after transplantation (NODAT), and delayed graft function. Results: 165 patients in the ATG group were matched to 298 patients in the BSX group with an average age of 64.3 and 64.2 years, respectively. During 28.5 ± 10.4 months of mean follow up the cumulative probability of death censored graft failure at 3-year posttransplantation were 1.3% and 1.4% in ATG and BSX group without significant difference (p = 0.720). Cumulative probability of NODAT at 3-year posttransplantation was significantly higher in BSX group (35.6% versus 21.6%, p = 0.021). Median Tacrolimus trough level was significantly lower in 6 months after kidney transplantation in the ATG group (5.7 ng/mL versus 6.4 ng/mL, p = 0.001). There was no difference in other evaluated outcomes. Conclusion: Compared to BSX, in elderly low-risk KT, ATG reduced Tacrolimus and steroid requirements without all-cause mortality, rejection, infection difference. Resulting in reduced NODAT incidence.

Outcomes of two-step haploidentical allogeneic stem cell transplantation in elderly patients with hematologic malignancies.

Allogeneic hematopoietic stem cell transplantation (allo-SCT) remains the best curative option for the majority of patients with hematologic malignancies (HM); however, many elderly patients are excluded from transplant and outcome data in this population is still limited. The novel two-step graft engineering approach has been the main platform for allo-SCT at Thomas Jefferson University since 2006. Following administration of the preparative regimen, we infuse donor lymphocytes, followed by cyclophosphamide to induce bidirectional tolerance, then infusion of CD34-selected cells. A total of 76 patients ≥ 65 years old with HM underwent haploidentical (haplo) allo-SCT on the two-step transplant platform between 2007 and 2021. The median time to neutrophil engraftment was 11 days and platelet engraftment was 18 days. With a median follow up of 44 months, the 3-year overall survival (OS) and progression-free survival (PFS) were 36.3% and 35.6%, respectively. The cumulative incidences of non-relapse mortality (NRM) and relapse at 3 years were 43.5% and 21.0% at 3 years, respectively. The cumulative incidence of grade III-IV acute graft-versus-host-disease (GVHD) was 11.1% at 6 months, and chronic GVHD requiring treatment was 15.1% at 2 years. The two-step haplo allo-SCT is a novel alternative platform for high-risk older HM patients, achieving fast engraftment, low relapse rates and promising survival.

Antithymocyte globulin versus basiliximab induction for kidney transplantation in elderly patients: matched analysis within the Korean multicentric registry.

BackgroundBasiliximab (BSX) and antithymocyte globulins (ATGs), are two major immunosuppressive agents commonly used as induction therapy for kidney transplant (KT) recipients. The superiority of ATG over BSX has not been well established, especially in elderly KT recipients with low immunological risk.MethodsA total of 847 elderly (≥60 years old), low-risk KT patients in the Korean Organ Transplantation Registry were propensity score-matched at a 1:2 ratio and compared according to ATG or BSX induction therapy. The primary outcome was patient and graft survival and biopsy-proven acute cellular rejection. The secondary outcome was graft function, BK virus nephropathy, infection, cancer, new-onset diabetes mellitus after transplantation (NODAT), and delayed graft function.ResultsIn total, 165 patients in the ATG group were matched with 298 patients in the BSX group with average ages of 64.3 and 64.2 years, respectively. During a follow-up of 28.5 ± 10.4 months, the cumulative probabilities of death-censored graft failure at 3 years posttransplantation were 1.3% and 1.4% in ATG and BSX groups, respectively, without a significant difference (p = 0.72). The cumulative probability of NODAT at 3 years posttransplantation was significantly higher in the BSX group (35.6% vs. 21.6%, p = 0.02). The median tacrolimus trough level was significantly lower at 6 months after KT in the ATG group (5.7 ng/mL vs. 6.4 ng/mL, p = 0.001). There were no differences in the other evaluated outcomes.ConclusionCompared with BSX, in elderly, low-risk KT patients, ATG reduced tacrolimus and steroid requirements without differences in all-cause mortality, rejection, or infection, resulting in a reduced NODAT incidence.

RATIONAL MAINTENANCE IMMUNOSUPPRESSION FOR ELDERLY RENAL TRANSPLANT RECIPIENTS. THE LITERATURE REVIEW

The main principle of immunosuppressive therapy, in the opinion of many authors, is gradually becoming the need to take into account all the advantages and disadvantages of the prescribed drugs in each particular patient. Individualization of lifelong immunosuppression acts as the main factor in long-term graft survival and, accordingly, in the life of the recipient. This review analyzes the literature on changes in the pharmacokinetics and pharmacodynamics of immunosuppressive drugs in elderly patients, and assesses the prospects for the correction of immunosuppressive therapy in kidney transplantation in elderly patients.

Current Status and Perspectives of Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients with Acute Myeloid Leukemia.

As in younger patients, allogeneic stem cell transplantation (alloHSCT) offers the best chance for durable remission in older patients (≥60 years) with acute myeloid leukemia (AML). However, defining the best treatment strategy (and in particular, whether or not to proceed to alloHSCT) for elderly patients with AML remains a difficult decision for the hematologist, since potential toxicity of conditioning regimens, risks of graft-versus-host disease, impaired immune reconstitution and the need for prolonged immunosuppression may be of major concern in these vulnerable patients with complex needs. Hopefully, significant progress has been made over the past decade in alloHSCT for elderly patients and current evidence suggests that chronological age per se (between 60 and 75) is not a reliable predictor of outcome after alloHSCT. Here, we review the current state of alloHSCT in elderly patients with AML and also discuss the different approaches currently being investigated to improve both accessibility to as well as success of alloHSCT in these patients.

Neurological Screening in Elderly Liver Transplantation Candidates: A Single Center Experience.

Background: Cerebral small vessels disease (cSVD) is an age-related disorder and risk factor for stroke and cognitive/motor impairments. Neurological complications (NCs) are among the causes of adverse outcomes in older liver transplant recipients. This study sought to determine whether cSVD predicts acute NCs in over 65-year-old liver transplant patients. Methods: Data were collected, from a retrospective medical chart review, of 22 deceased donor liver transplant recipients aged 65 years or older with a pre-operative brain magnetic resonance imaging (MRI). We used the Fazekas score (0–3) as a quantitative measurement of the vascular lesion load seen in the MRI. We analyzed all post-operative acute NCs occurring during the hospital stay and any other non-NC. Results: cSVD was recognized in all patients. Neurological complications (NCs) occurred in 18.1% of patients with toxic-metabolic encephalopathy the most frequent diagnosis (13.64%). More severe cSVD was associated with seizures (p = 0.0362), longer hospital stay (p 0.0299), and disability (p 0.0134). In our elderly cohort, hepatic encephalopathy (HE) (p 0.0287) and ascites (p 0.0270) were predictors of NCs after liver transplantation. Ascites and/or variceal bleeding and severity of liver disease were associated with adverse post-operative outcomes. The small sample size limited the statistical analysis power. Conclusions: We present the preliminary data of a single-center retrospective study aimed at understanding the cSVD role on NCs and non-NCs after a liver transplantation in elderly patients. This would encourage a more appropriate multicenter prospective study that will definitely confirm if a neurological screening in old age liver transplant candidates is appropriate.

Donor Age Influences Graft-Versus-Host Disease Relapse-Free Survival after Allogeneic Stem Cell Transplant in Elderly Patients in Two Countries from Latin America.

Allogeneic stem cell transplantation (Allo-SCT) in elderly patients is a growing practice. We aimed to determine the graft-versus-host disease (GVHD) relapse-free survival (GRFS) in patients ≥65 years who underwent Allo-SCT in two countries from Latin America. We performed a retrospective analysis of patients ≥65 years who underwent Allo-SCT in Argentina and Brazil from 2007 to 2019. Ninety-eight patients were evaluated, with primary diagnoses of acute myeloid leukemia and myelodysplastic syndrome; 30% of patients had a hematopoietic cell transplant-comorbidity index (HCT-CI) score ≥3 and 49% were in complete remission. Donor types included matched sibling (n = 41), matched unrelated (n = 31), and haploidentical (HID; n = 26) donors. The conditioning regimen was myeloablative in 28 patients (14 busulfan pharmacokinetically [PK]-guided) and reduced-intensity in 70 patients. The two-year non-relapse mortality (NRM) was 29%, with a higher NRM in melphalan-based compared to other conditionings (51% vs. 33%, p = 0.02). The two-year relapse rate was 24%, with a reduction in PK-guided busulfan (0% vs. 28%, p = 0.03). The two-year overall survival (OS) and GRFS was 52% and 38%, respectively, with a significant reduction in GRFS in HCT-CI ≥3 (27% vs. others 42%, p = 0.02) and donors ≥40 years (29% vs. <40 years 55%, p = 0.02). These variables remained significantly associated with GRFS after multivariate analysis. In this cohort of elderly patients from Argentina and Brazil undergoing Allo-SCT, donor age and comorbidities significantly influenced GRFS. The role of the conditioning regimen in this population deserves further investigation.

The Outcome of Autologous Hematopoietic Cell Transplantation in Elderly Patients with Aggressive Non-Hodgkin Lymphoma

Introduction: High-dose chemotherapy followed by autologous hematopoietic cell transplantation (AHCT) may provide survival benefit in patients with non-hodgkin lymphoma (NHL). Retrospective analyses suggest that the benefit of HDT extends to elderly patients with NHL, which is an important finding considering that the median age at diagnosis is 67 years (range: 65-74) for NHL in United States, using 2010-2014 US SEER data. We aimed to define the efficacy and toxicity of AHCT in patients >60 years with NHL.Patients and Methods: From January 2005 through January 2021, data from 36 patients with aggressive NHL above 60 years of age who were eligible for AHCT according to geriatric assessment (GA) were evaluated. Their diagnoses were as following; 21 diffuse large B cell lymphoma (primary refractory or relapsed disease), 11 mantle cell lymphoma (first complete remission), 2 follicular lymphoma, 1 peripheral T cell lymphoma and 1 anaplastic large cell lymphoma. We compared the toxicity profile and outcome between the research group: patient aged 60 years and above and the control group: patient <60 years.Results: All of the patients were stage III or IV at diagnosis; ten out of 36 elderly patients had active disease at the time of AHCT. The median follow-up was 20.5 months (range, 1-60 mos). Prior to transplantation majority (85%) of the elderly patients received BEAM protocol as conditioning treatment. Bone marrow stem cell was used in only 1 patient None of the patient had mobilization failure, the median peripheral CD34 level was 5.24x10 6/kg. Forty-eight percent of the patients experienced grade 3-4 mucositis and 77% of the patients had microbiology-documented infection. Sixty-two percent of the patients had diarrhea with median duration of 8 days (range, 5-20 days). Renal toxicity was occurred in 7 (27%) patients while hepatic toxicity in 1(10%) patients. Median time to neutrophil recovery was 10 days (range, 8-18 days) and platelet recovery 11 days (range, 10-32 days). Overall response was obtained from all patients (23% CR). At the time of data collection, 7 patients (19.4%) of patients' ≥ 60 years have deceased. Relapse (n=3) was the main course of death. The probability of 4-year progression free survival (PFS) and estimated overall survival (OS) in elderly patients were 44.4% and 39.4%, respectively.Conclusion: Based on this single center study, AHCT is safe and efficacious in the treatment of elderly lymphoma patients. We emphasize the need for further research in order to determine the risk-benefit threshold for stem cell transplantation based on age coupled with comorbidity and fragility. DisclosuresÖzcan: Bayer: Research Funding; Archigen: Research Funding; Amgen: Honoraria, Other: Travel/Accommodations/Expenses; Janssen: Other: Travel/Accommodations/Expenses, Research Funding; Roche: Other: Travel/Accommodations/Expenses, Research Funding; Celgene: Research Funding; MSD: Research Funding; Abbvie: Other: Travel/Accommodations/Expenses, Research Funding; AstraZeneca: Research Funding; Takeda: Honoraria, Other: Travel/Accommodations/Expenses, Research Funding; Pfizer: Research Funding; BMS: Other: Travel/Accommodations/Expenses; Jazz: Other: Travel/Accommodations/Expenses; Sanofi: Other: Travel/Accommodations/Expenses; Abdi Ibrahim: Other: Travel/Accommodations/Expenses. Beksac: Amgen,Celgene,Janssen,Takeda,Oncopeptides,Sanofi: Consultancy, Speakers Bureau.

Immunosenescence as a reason of individualizing immunosuppressive therapy in kidney transplantation

Transplantation in elderly patients is obviously more challenging due to existing underlying diseases, changes in pharmacokinetics of immunosuppressive drugs, polypragmasy, and transformation of immunoreactivity (immunosenescence). Our review presents data on modification of adaptive and innate immunity during aging. It also considers the possibility of both reduced and adapted immunosuppressive therapy in elderly renal transplant recipients in achieving an optimal balance between efficacy and complications.

MM-254: Autologous Hematopoietic Stem Cell Transplantation in Elderly Patients with Multiple Myeloma as a Standard Therapeutic Procedure. Is it Feasible? Single Center Experience

Context Autologous peripheral blood stem cell transplant (PBSCT) ideally should be performed in every myeloma patient, but in the elderly, the procedure might be risky because of comorbidities, and the possibility of the organism to fully compensate possible complications. Objective Our main goal was to show that the age limit for autologous PBSCT in myeloma patients can be safely shifted upwards. Design We used conditioning with melphalan, followed by autologous PBSCT for elderly patients with myeloma, using the age limit of 65 years. Setting All patients were transplanted in the bone marrow transplant unit in the University Clinic for Hematology Skopje. They underwent standard post-transplant preventive and prophylactic measures during the period of pancytopenia. Patients or Other Participants We have done a retrospective analysis of patients with MM where autologous SCT was done. The main inclusion criteria was the diagnosis, age over 65, acceptable comorbidity profile. Interventions Mobilizing and harvesting of stem cells, melphalan conditioning, and application of the graft via central venous catheter were standard for all patients. Main Outcomes Measures We evaluated the rates of transplant related mortality (TRM), post-transplant follow-up, complete remission (CR). Results Our analysis of data for 20 years shows that we performed autologous PBSCT on 25 patients with myeloma at the age of 65 or older. 17 males (68%) and 8 female (32%). Average age was 67 years (65-73). All patients received melphalan conditioning. In 23 of the patients, we used non-cryopreserved hematopoietic stem cells. In two patients we performed tandem autologous PBSCT with no major complications. 75% had HTA, 20% some level of cardiomyopathy, 48% diabetes, and 12% with inserted prosthetic aortic valves. Our oldest patient was 73 years old and was still alive 2 years posttransplant. Our transplant related mortality was 0%. Conclusions Autologous PBSCT in elderly myeloma patients can be safe and effective, with careful selection of patients, balancing the risk profile of the patient, and the benefit of the procedure. Affective supportive care, monitoring, and reducing the risk of complications is an imperative to a good result. Autologous peripheral blood stem cell transplant (PBSCT) ideally should be performed in every myeloma patient, but in the elderly, the procedure might be risky because of comorbidities, and the possibility of the organism to fully compensate possible complications. Our main goal was to show that the age limit for autologous PBSCT in myeloma patients can be safely shifted upwards. We used conditioning with melphalan, followed by autologous PBSCT for elderly patients with myeloma, using the age limit of 65 years. All patients were transplanted in the bone marrow transplant unit in the University Clinic for Hematology Skopje. They underwent standard post-transplant preventive and prophylactic measures during the period of pancytopenia. We have done a retrospective analysis of patients with MM where autologous SCT was done. The main inclusion criteria was the diagnosis, age over 65, acceptable comorbidity profile. Mobilizing and harvesting of stem cells, melphalan conditioning, and application of the graft via central venous catheter were standard for all patients. We evaluated the rates of transplant related mortality (TRM), post-transplant follow-up, complete remission (CR). Our analysis of data for 20 years shows that we performed autologous PBSCT on 25 patients with myeloma at the age of 65 or older. 17 males (68%) and 8 female (32%). Average age was 67 years (65-73). All patients received melphalan conditioning. In 23 of the patients, we used non-cryopreserved hematopoietic stem cells. In two patients we performed tandem autologous PBSCT with no major complications. 75% had HTA, 20% some level of cardiomyopathy, 48% diabetes, and 12% with inserted prosthetic aortic valves. Our oldest patient was 73 years old and was still alive 2 years posttransplant. Our transplant related mortality was 0%. Autologous PBSCT in elderly myeloma patients can be safe and effective, with careful selection of patients, balancing the risk profile of the patient, and the benefit of the procedure. Affective supportive care, monitoring, and reducing the risk of complications is an imperative to a good result.