The first global study of HCT for SAA in older patients.
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Age does not impact on survival.
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Choice of GVHD prophylaxis and performance score impact on outcomes.
Abstract
We report on 499 patients with severe aplastic anemia aged ≥50 years who underwent hematopoietic cell transplantation (HCT) from HLA-matched sibling (n=275), or HLA-matched (8/8) unrelated donors (n=39187) between 2005 and 2016. The median age at HCT was 57.8 years; 16% of patients were 65-77 years old. Multivariable analysis confirmed higher mortality risks for patients with performance score less than 90% (HR 1.41 (1.03-1.92), p=0.03) and after unrelated donor transplantation (HR 1.47 (1-2.16), p=0.05). The 3-year probabilities of survival for patients with performance score 90-100 and less than 90 after HLA-matched sibling transplant were 66% (57-75%) and 57% (47-76%), respectively. The corresponding probabilities after HLA-matched unrelated donor transplantation were 57% (48-67%) and 48% (36-59%). Age at transplantation was not associated with survival but grade II-IV acute GVHD risks were higher for patients aged 65 years or older (sHR 1.7 (1.07-2.72), p=0.026). Chronic GVHD was lower with GVHD prophylaxis regimens calcineurin inhibitor (CNI) + methotrexate (sHR 0.52 (0.33-0.81), p=0.004) and CNI alone or other agents (sHR 0.27 (0.14-0.53), p<0.001) compared to CNI + mycophenolate. While donor availability is modifiable only to a limited extent, choice of GVHD prophylaxis and selection of patients with good performance scores are key for improved outcomes.
