What is the prognosis of allogeneic hematopoietic stem cell transplantation in 2022 EBMT elderly patients with acute myeloid leukemia?

The median age at onset of acute myeloid leukemia (AML) is approximately 68 years
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Because increasing age is associated with impaired functional status and increased incidence of comorbidities, and allogeneic hematopoietic stem cell transplantation (allo-HSCT) is associated with higher rates of transplant complications and associated mortality, it is generally not recommended for patients over 70 years of age use
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However, with improvements in transplant procedures in recent years, allo-HSCT can be performed in selected elderly patients
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Italian and Turkish investigators conducted separate studies to explore the outcomes of allo-HSCT in elderly patients with AML
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Both studies were selected for the poster presentation of the 48th European Society of Blood and Marrow Transplantation (EBMT) Annual Meeting in 2022.
The editor will organize the main contents as follows for the reference of readers
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Abstract No.
P554 Title: Feasibility of haploid hematopoietic stem cell transplantation after myeloablative conditioning in AML patients over 70 years of age: a single-center empirical study Methods investigators retrospectively collected data from November 2019 to October 2021 Data from 4 patients over 70 years of age who underwent HLA haploidentical transplantation after myeloablative conditioning (MAC) with Treosulfan in Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (Milan, Italy)
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Conditioning regimens included 10 or 12 g/mq sufenamide on days -6 to -4, 30 mg/mq fludarabine on days -6 to -2, and a single dose of 5 mg/mq on days -3 kg Thiotepa
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Patients received peripheral blood from haploid donors as a source of stem cells for allo-HSCT
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Graft-versus-host disease (GVHD) prophylaxis included antithymocyte globulin (ATG) 1.
25 mg/kg on days -3 and -2 and post-transplant cyclophosphamide (PTCy) 50 mg/mq on days +3 and +4 , mycophenolate mofetil (MMF) and cyclosporine (CsA) from day +5
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CMV-positive patients received letermovir prophylaxis until day +100
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Study results Patient and transplant characteristics are shown in the table below
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The median time from diagnosis to allo-HSCT was 219 days (range: 175-640 days)
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Three 74-year-old patients received 10 g/mq of thalbuterol, and one 71-year-old patient received 12 g/mq of thalbuterol
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The median time to neutrophil and platelet engraftment was 18.
5 days (range: 16-22 days) and 13 days (range: 11-23 days), respectively
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Early complications include neutropenic fever (up to grade III), atrial fibrillation (up to grade III), and mucositis (up to grade II)
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Two patients developed grade I acute GVHD involving only the skin and recovered completely with low-dose prednisone
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One patient developed mild chronic cutaneous GVHD with no indication for treatment
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One patient's cardiac ejection fraction worsened from 52% at baseline to 45% at 400 days after allo-HSCT
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After a median of 361 days (range: 51-539 days), all patients were alive in complete remission with complete donor mosaicism
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Table: Patient Characteristics at Transplant Study Conclusions The study results demonstrate the feasibility of haploidentical allo-HSCT in AML patients over 70 years of age, and no serious complications were found
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Conditioning regimens containing a single dose of thiotepa were well tolerated
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Low-dose ATG combined with the classic PTCy/CsA/MMF regimen appears to be very effective in preventing acute and chronic GVHD
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In conclusion, the findings of this study support the treatment of MAC allo-HSCT in healthy patients over 70 years of age
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Abstract No.
: P555 ​​Title: Allogeneic hematopoietic stem cell transplantation in elderly AML patients: A single-center empirical study approach From 2004 to 2021, 31 patients (age ≥60 years) who underwent allo-HSCT at Ankara University Hospital were This retrospective study was included
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To determine pre-transplant status as well as post-transplant toxicity, complications, and prognosis
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Study Results The following table summarizes patient characteristics and transplant outcomes
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Twenty-three patients were aged 60-65 years, and 8 patients were over 65 years old
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The median time to neutrophil engraftment (>0.
5x109/L) and platelet engraftment (20x109/L) was 19 days (range: 11-38) and 24 days (range: 15-36), respectively
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Post-transplant complications are detailed in the table below
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Nine patients (29%) developed acute GVHD and seven patients (22%) developed chronic GVHD, with a 1-year recurrence-free survival rate of 45%
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Table: Patient characteristics and post-transplant complications 1- and 2-year overall survival (OS) rates were 45% and 19%, respectively
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At the end of the long-term follow-up, 20 patients died, and the most common cause of death was the recurrence of the primary disease
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Conclusions As more elderly patients are diagnosed with hematological malignancies, the number of cases undergoing allo-HSCT will continue to increase
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Despite the relatively small study population, reduced-intensity conditioning and pretransplant remission status may be associated with better survival
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A comprehensive evaluation of older patients may be considered prior to allo-HSCT
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Reference source: 1.
K.
Barbullushi, F.
Cavallaro, F.
Serpenti, et al.
FEASIBILITY OF MYELOABLATIVE ALLO-SCT FROM HAPLOIDENTICAL DONOR IN AML PATIENTS OLDER THAN 70 YEARS: A SINGLE-CENTRE EXPERIENCE.
The 48th Annual Meeting of the EBMT .
Abstract P554.
2.
O.
Ilhan, G.
Yavuz, G.
Cengiz Seval, et al.
ALLOGENEIC HEMATOPOIETIC STEM CELL TRANSPLANTATION IN ELDERLY PATIENTS WITH ACUTE MYELOID LEUKEMIA: A SINGLE CENTER EXPERIENCE.
The 48th Annual Meeting of the EBMT.
Abstract P555 .
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