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

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, B E; Cook, G; Craddock, C

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.

Citation

Nikolousis, E., Nagra, S., Pearce, R., Perry, J., Kirkland, K., Byrne, J., …Craddock, C. (2014). 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 Transplantation, 50, 82-86. https://doi.org/10.1038/bmt.2014.215

• Journal Article Type: Article
• Acceptance Date: Jan 18, 2014
• Online Publication Date: Oct 6, 2014
• Publication Date: Oct 6, 2014
• Deposit Date: Jan 31, 2018
• Print ISSN: 0268-3369
• Electronic ISSN: 1476-5365
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 50
• Pages: 82-86
• DOI: https://doi.org/10.1038/bmt.2014.215
• Public URL: https://nottingham-repository.worktribe.com/output/1100164
• Publisher URL: https://www.nature.com/articles/bmt2014215
• PMID: 25285801