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Hematopoietic cell transplantation in older adults: deciding or decision-making?

Bone Marrow Transplantation volume 51, pages 643–644 (2016)Cite this article

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Historically, the high toxicities of allogeneic hematopoietic cell transplantation (HCT) precluded this therapy in older adults. However, with more tolerable regimens, better donor selection and better supportive care, allogeneic transplant has moved quickly to patients ⩾60 years, which actually represents the area of greatest growth.1 Many studies have shown reasonable outcomes after allogeneic HCT indicating older age alone is not a barrier to HCT.2, 3 It still remains true very few transplants are offered to patients >75 years of age and that in most large series, older age, among those medically cleared to undergo HCT, is still associated with higher risks of non-relapse death after both autologous and allogeneic HCT.4, 5

For diseases such as AML, the poor prognosis in older adults after standard therapy forces the question of whether to pursue allogeneic HCT.6, 7 Unfortunately, we lack well-designed studies documenting the risks and benefits of transplant versus non-transplant strategies. In the Fellowship of the Ring from the Lord of the Rings Stories by JRR Tolkien, Gandalf famously says ‘…All we have to decide is what to do with the time that is given us.’ Patients diagnosed with most hematologic malignancies face these same issues of fatalism with a life-limiting disease. The question about what to do with the remaining time rings true for older adults considering the transplant. Should one pursue therapy for curative intent and potentially sacrifice their quantity or quality of life? In looking at patient preferences for treatment, weighing quantity versus quality of life, an understanding of the decision-making process is important.

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Authors and Affiliations

  1. Department of Medicine, University of Chicago,

    A S Artz

  2. Section of Hematology/Oncology, Chicago, IL, USA

    A S Artz

  3. Department of Medicine, University of Chicago,

    S Chow

  4. Section of Geriatrics and Palliative Medicin,

    S Chow

  5. e, Chicago, IL, USA

    S Chow

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  1. A S Artz
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Correspondence to A S Artz.

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Artz, A., Chow, S. Hematopoietic cell transplantation in older adults: deciding or decision-making?. Bone Marrow Transplant 51, 643–644 (2016). https://doi.org/10.1038/bmt.2016.86

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