Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Post-Transplant Events

Retrospective analysis of common scoring systems and outcome in patients older than 60 years treated with reduced-intensity conditioning regimen and alloSCT

Bone Marrow Transplantation volume 46, pages 1000–1005 (2011)Cite this article

Subjects

Abstract

In this retrospective study, 63 patients >60 years with hematological malignancies and treated with allo-SCT and with reduced-intensity conditioning (RIC) were reviewed. A total of 51% of patients suffered from AML or myelodysplastic syndromes. Disease status before transplantation was CR or PR 71 with 29% transplanted with active disease. Patients were classified according to three published prognostic indexes: (1) hematopoietic cell transplantation comorbidity index (HCT-CI); (2) European BMT (EBMT) score; and (3) Pretransplantation Assessment of Mortality (PAM) score. The 100-day and 1-year treatment-related mortality (TRM) were 6 and 22%, respectively, for the entire group. The 2-year OS and PFS were 60 and 58%, respectively. The incidence of grade II–IV acute GVHD (aGVHD) and extensive chronic GVHD was 46 and 48%, respectively. In a univariate analysis, neither the HCT-CI nor the EBMT score, nor the PAM score were predictive of TRM and OS. Only the occurrence of aGVHD affected the TRM and OS. ALLO-RIC is feasible in elderly patients. Even if those prognostic scores were not adapted to elderly patients, they did not predict for TRM and OS. aGVHD is the main cause of TRM and more efforts should be made to reduce its incidence without sacrificing graft vs tumor effect.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Blaise D, Vey N, Faucher C, Mohty M . Current status of reduced-intensity-conditioning allogeneic stem cell transplantation for acute myeloid leukemia. Haematologica 2007; 92: 533–541.

    Article  Google Scholar 

  2. McClune BL, Weisdorf DJ, Pedersen TL, Tunes da Silva G, Tallman MS, Sierra J et al. Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome. J Clin Oncol 2010; 28: 1878–1887.

    Article  Google Scholar 

  3. Gupta V, Daly A, Lipton JH, Hasegawa W, Chun K, Kamel-Reid S et al. Nonmyeloablative stem cell transplantation for myelodysplastic syndrome or acute myeloid leukemia in patients 60 years or older. Biol Blood Marrow Transplant 2005; 11: 764–772.

    Article  Google Scholar 

  4. Falda M, Busca A, Baldi I, Mordini N, Bruno B, Allione B et al. Gruppo Italiano Trapianto Midollo Osseo (GITMO). Nonmyeloablative allogeneic stem cell transplantation in elderly patients with hematological malignancies: results from the GITMO (Gruppo Italiano Trapianto Midollo Osseo) multicenter prospective clinical trial. Am J Hematol 2007; 82: 863–866.

    Article  CAS  Google Scholar 

  5. Bertz H, Potthoff K, Finke J . Allogeneic stem-cell transplantation from related and unrelated donors in older patients with myeloid leukemia. J Clin Oncol 2003; 21: 1480–1484.

    Article  Google Scholar 

  6. Spyridonidis A, Bertz H, Ihorst G, Grüllich C, Finke J . Hematopoietic cell transplantation from unrelated donors as an effective therapy for older patients (> or = 60 years) with active myeloid malignancies. Blood 2005; 105: 4147–4148.

    Article  CAS  Google Scholar 

  7. Shapira MY, Resnick IB, Bitan M, Ackerstein A, Samuel S, Elad S et al. Low transplant-related mortality with allogeneic stem cell transplantation in elderly patients. Bone Marrow Transplant 2004; 34: 155–159.

    Article  CAS  Google Scholar 

  8. Charlson ME, Pompei P, Ales KL, MacKenzie CR . A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.

    Article  CAS  Google Scholar 

  9. Sorror ML, Maris MB, Storb R, Baron F, Sandmaier BM, Maloney DG et al. Hematopoietic cell transplantation (HCT)-specific comorbidity index: a new tool for risk assessment before allogeneic HCT. Blood 2005; 106: 2912–2919.

    Article  CAS  Google Scholar 

  10. Sorror M, Storer B, Sandmaier BM, Maloney DG, Chauncey TR, Langston A et al. Hematopoietic cell transplantation-comorbidity index and Karnofsky performance status are independent predictors of morbidity and mortality after allogeneic nonmyeloablative hematopoietic cell transplantation. Cancer 2008; 112: 1992–2001.

    Article  Google Scholar 

  11. Farina L, Bruno B, Patriarca F, Spina F, Sorasio R, Morelli M et al. The hematopoietic cell transplantation comorbidity index (HCT-CI) predicts clinical outcomes in lymphoma and myeloma patients after reduced-intensity or non-myeloablative allogeneic stem cell transplantation. Leukemia 2009; 23: 1131–1138.

    Article  CAS  Google Scholar 

  12. Pollack SM, Steinberg SM, Odom J, Dean RM, Fowler DH, Bishop MR . Assessment of the hematopoietic cell transplantation comorbidity index in non-Hodgkin lymphoma patients receiving reduced-intensity allogeneic hematopoietic stem cell transplantation. Biol Blood Marrow Transplant 2009; 2: 223–230.

    Article  Google Scholar 

  13. Parimon T, Au DH, Martin PJ, Chien JW . A risk score for mortality after allogeneic hematopoietic cell transplantation. Ann Intern Med 2006; 144: 407–414.

    Article  Google Scholar 

  14. Gratwohl A, Stern M, Brand R . Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis. Cancer 2009; 115: 4715–4726.

    Article  Google Scholar 

  15. Mohty M, Bay JO, Faucher C, Choufi B, Bilger K, Tournilhac O et al. Graft-versus-host disease following allogeneic transplantation from HLA-identical sibling with antithymocyte globulin-based reduced-intensity preparative regimen. Blood 2003; 102: 470–476.

    Article  CAS  Google Scholar 

  16. Kaplan EL, Meier P . Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.

    Article  Google Scholar 

  17. Estey E, de Lima M, Tibes R, Pierce S, Kantarjian H, Champlin R et al. Prospective feasibility analysis of reduced-intensity conditioning (RIC) regimens for hematopoietic stem cell transplantation (HSCT) in elderly patients with acute myeloid leukemia (AML) and high-risk myelodysplastic syndrome (MDS). Blood 2007; 109: 1395–1400.

    Article  CAS  Google Scholar 

  18. Xhaard A, Porcher R, Chien JW, de Latour RP, Robin M, Ribaud P et al. Impact of comorbidity indexes on non-relapse mortality. Leukemia 2008; 22: 2062–2069.

    Article  CAS  Google Scholar 

  19. Guilfoyle R, Demers A, Bredeson C, Richardson E, Rubinger M, Szwajcer D et al. Performance status, but not the hematopoietic cell transplantation comorbidity index (HCT-CI), predicts mortality at a Canadian transplant center. Bone Marrow Transplant 2009; 43: 133–139.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We thank the nursing staff for providing excellent care for our patients, and the physicians of the Hematology Department at the Institut Paoli-Calmettes for their important study contributions and dedicated patient care. We thank BF Petersen for revising the paper. Part of this work benefited from a special grant from the ‘Association pour la Recherche Contre le Cancer (ARC)’ (program ARECA).

Author information

Authors and Affiliations

  1. Hematology Department, Transplantation Program, Institut Paoli Calmettes, Marseille, France

    L Castagna, S Fürst, J El Cheikh, C Faucher & D Blaise

  2. Hematology Department, Maciel Hospital, Montevideo, Uruguay

    N Marchetti

  3. Hematology Department, CHU Nantes, Nantes, France

    M Mohty

  4. Hematology Department, Lymphoma Program, Institut Paoli Calmettes, Marseille, France

    R Bouabdallah

  5. Hematology Department, Leukemia Program, Institut Paoli Calmettes, Marseille, France

    N Vey

  6. Hematology Department, Myeloma Program, Institut Paoli Calmettes, Marseille, France

    A M Stoppa

  7. Biostatistic Department, Institut Paoli Calmettes, Marseille, France

    B Esterni

Authors
  1. L Castagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S Fürst
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N Marchetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J El Cheikh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C Faucher
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M Mohty
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R Bouabdallah
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. N Vey
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A M Stoppa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. B Esterni
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. D Blaise
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L Castagna.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Castagna, L., Fürst, S., Marchetti, N. et al. Retrospective analysis of common scoring systems and outcome in patients older than 60 years treated with reduced-intensity conditioning regimen and alloSCT. Bone Marrow Transplant 46, 1000–1005 (2011). https://doi.org/10.1038/bmt.2010.227

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2010.227

Keywords

This article is cited by

Search

Advanced search

Quick links