TY  - JOUR
A1  - Rice, Carmel
A1  - Eikema, Dirk-Jan
A1  - Marsh, Judith C. W.
A1  - Knol, Cora
A1  - Hebert, Kyle
A1  - Putter, Hein
A1  - Peterson, Eefke
A1  - Deeg, H. Joachim
A1  - Halkes, Stijn
A1  - Pidala, Joseph
A1  - Anderlini, Paolo
A1  - Tischer, Johanna
A1  - Kroger, Nicolaus
A1  - McDonald, Andrew
A1  - Antin, Joseph H.
A1  - Schaap, Nicolaas P.
A1  - Hallek, Michael
A1  - Einsele, Herman
A1  - Mathews, Vikram
A1  - Kapoor, Neena
A1  - Boelens, Jaap-Jan
A1  - Mufti, Ghulam J.
A1  - Potter, Victoria
A1  - de la Tour, Régis Pefault
A1  - Eapen, Mary
A1  - Dufour, Carlo
T1  - Allogeneic Hematopoietic Cell Transplantation in Patients Aged 50 Years or Older with Severe Aplastic Anemia
JF  - Biology of Blood and Marrow Transplantation
N2  - We report on 499 patients with severe aplastic anemia aged >= 50 years who underwent hematopoietic cell transplantation (HCT) from HLA-matched sibling (n = 275, 55%) or HLA-matched (8/8) unrelated donors (n =187, 37%) between 2005 and 2016. The median age at HCT was 57.8 years; 16% of patients were 65 to 77 years old. Multivariable analysis confirmed higher mortality risks for patients with performance score less than 90% (hazard ratio HR], 1.41; 95% confidence interval [CI], 1.03 to 1.92; P= .03) and after unrelated donor transplantation (HR, 1.47; 95% CI,1 to 2.16; P = .05). The 3-year probabilities of survival for patients with performance scores of 90 to 100 and less than 90 after HLA-matched sibling transplant were 66% (range, 57% to 75%) and 57% (range, 47% to 76%), respectively. The corresponding probabilities after HLA-matched unrelated donor transplantation were 57% (range, 48% to 67%) and 48% (range, 36% to 59%). Age at transplantation was not associated with survival, but grades II to IV acute graft-versus-host disease (GVHD) risks were higher for patients aged 65 years or older (subdistribution HR [sHR], 1.7; 95% confidence interval, 1.07 to 2.72; P= .026). Chronic GVHD was lower with the GVHD prophylaxis regimens calcineurin inhibitor (CNI) + methotrexate (sHR, .52; 95% CI, .33 to .81; P= .004) and CNI alone or with other agents (sHR, .27; 95% CI, .14 to .53; P < .001) compared with CNI + mycophenolate. Although 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. (C) 2018 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.
KW  - Aplastic anemia
KW  - Hematopoietic cell transplant
KW  - Survival
Y1  - 2019
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-225229
VL  - 25
IS  - 3
ER  -