Transplantation in the Elderly: The Affect of Age on Clinical Course and Outcomes.

Abstract

Abstract Hematopoietic stem cell transplant (HSCT) is often the treatment of choice for a number of hematologic malignancies at the time of relapse. Historically, older patients have been excluded from receiving HSCT due to concerns about the potential for increased toxicity and treatment related mortality (TRM). We performed a retrospective analysis of patients undergoing autologous HSCT over a six year time period at our institution evaluating age as a prognostic factor. Adult patients (18 years and over) who received a HSCT between the years 2000 and 2006 were evaluated. The patients were divided into two cohorts based on age, the “senior” cohort (≥62 years) and the “younger” cohort (≤61 years). Individual patient chart reviews yielded pertinent information. Of the 181 patients who received a transplant during this time period, 131 patients (median age of 50 years: range 19–61) comprised the “younger” cohort and 50 patients (median age of 66 years: range 62–73) were included within the “senior” cohort. There was no statistical difference between these two groups when the following were evaluated: time to engraftment (p values of 0.13 for neutrophils and 0.2 for platelets), length of hospital stay (p = 0.5), incidence of infection (p = 1), transfer to the ICU (p = 0.08) or TRM (p = 0.3). This analysis is the largest study of its size evaluating outcome of autologous HSCT based on age using current transplant protocols, including primarily peripheral stem cell transplants. It is also the first study to specifically address incidence of infection in older patients, which has been suggested by other studies to increase TRM in elderly patients. Our data indicate that toxicity of autologous HSCT is similar in older patients when compared to younger patients and that this treatment should be offered to elderly patients with hematologic malignancies who may benefit from autologous stem cell transplantation.