Nonmyeloablative Transplantation With High-Dose Cyclophosphamide May Improve Outcomes in Older Patients With Hematologic Malignancy


Key Points

  • No significant differences in grade 3 or 4 acute graft-vs-host disease were observed according to age.
  • No significant differences according to age were observed for nonrelapse mortality, relapse, or survival.

 In a recent report of single-institution experience in the Journal of Clinical Oncology, Kasamon et al found that nonmyeloablative-related HLA-haploidentical blood or marrow transplantation (BMT) followed by high-dose cyclophosphamide produced good outcomes in patients aged 50 to 75 years with hematologic malignancies.

Study Details

The retrospective analysis included 271 consecutive patients aged 50 to 75 years who were treated with nonmyeloablative, T-cell–replete haplo-BMT followed by high-dose cyclophosphamide at Johns Hopkins University Hospital between January 2003 and June 2013. Patients had a median age of 61 years, with 42% aged 50 to 59 years, 48% aged 60 to 69 years, and 10% aged 70 to 75 years. A total of 84% had intermediate- or high-/very high-risk disease.

Graft-vs-Host Disease, Nonrelapse Mortality

Overall, the 6-month probability of grade 3 or 4 acute graft-vs-host disease was 3%, including rates of 4%, 3%, and 0% for patients in their 50s, 60s, and 70s. Older patient age was associated with a significantly higher risk of cumulative grade 2 to 4 acute graft-vs-host disease (subdistribution hazard ratio = 1.67, P = .03, for age ≥ 60 vs 50 to 59 years) but not grade 3 or 4 graft-vs-host disease. The 6-month probability of nonrelapse mortality was 8%, including rates of 8%, 9%, and 7% in patients in their 50s, 60s, and 70s (P = .20).


After median follow-up of 4 years, 3-year progression-free survival probabilities were 39%, 35%, and 33% (P = .65), and 3-year overall survival probabilities were 48%, 45%, and 44% (P = .66) for patients in their 50s, 60s, and 70s. Three-year progression-free survival probabilities were 40% in acute myeloid leukemia (n = 65), 39% in aggressive non-Hodgkin lymphoma (n = 83), and 37% in indolent or mantle cell lymphoma (n = 65). Overall, there were no significant differences by age in nonrelapse mortality, relapse, or survival with age as a continuous variable or for older age vs 50 to 59 years.

The investigators concluded, “[Nonmyeloablative] haplo-BMT with post-transplantation cyclophosphamide has encouraging safety and survival outcomes in patients age 50 to 75 years. In patients otherwise fit for BMT, the results support consideration of this approach despite advanced age.”

Richard J. Jones, MD, Johns Hopkins University, is the corresponding author of the Journal of Clinical Oncology article.

The study was supported by the National Institutes of Health.

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