Elderly experience ‘impressive improvement’ in survival after stem cell transplant
Click Here to Manage Email Alerts
Key takeaways:
- Over the last 2 decades, 3-year cumulative relapse incidence decreased among elderly patients with AML.
- OS and 3-year leukemia-free survival also both improved over the last 2 decades.
Among elderly patients with acute myeloid leukemia, survival outcomes for those who received an allogenic stem cell transplant have improved significantly over the past 2 decades, according to data published in Clinical Cancer Research.
Researchers attributed the improvements in survival more to decreased relapse incidence rather than decreased nonrelapse mortality, researchers wrote.
“In tandem with the marked increase in elderly patients receiving allo-HCT, we observed an impressive improvement over time in leukemia-free and overall survival,” Ali Bazarbachi, MD, PhD, professor of medicine at the American University of Beirut in Lebanon, said in a press release. “These data indicate that allo-HCT should no longer be optional but should be mandatory for elderly patients.”
Background, methods
AML is a disease that affects older patients, with a median diagnosis age of 68 years, according to researchers. Improvements in allogenic hematopoietic cell transplantation (allo-HCT) have allowed for the delivery of allo-HCT to older patients, so researchers conducted a retrospective, registry-based study to assess temporal changes in transplant characteristics and outcomes among patients with AML over the age of 64 years.
Researchers identified 7,215 patients with AML who had received an allograft between 2000 and 2021 — 64% in first complete remission, 14% in second or subsequent remission and 22% with active disease.
Leukemia-free and overall survival served as the study’s primary endpoints, with a median follow-up of 40 months during the study.
Results, next steps
At a median follow-up of 40 months, researchers noted a 3-year cumulative relapse incidence rate of 37% between 2000 and 2009, with decreasing to 31% between 2010 and 2014, and to 30% between 2015 and 2021. They reported a nonrelapse mortality rate of 31% during the first two time periods before dipping to 27% between 2015 and 2021.
Researchers also reported that 3-year leukemia-free survival and OS improved significantly over the study period. The three-year leukemia-free survival rate increased from 32% to 38% and then to 44% over the three time periods, with OS improving from 37% to 42% to 49%.
A multivariable analysis showed significant improvements in relapse incidence , leukemia-free survival and OS occurring after 2015, whereas nonrelapse mortality did not experience a significant change. Improvements in survival outcomes occurred regardless of a patient’s disease status at the time of transplant.
Researchers noted potential study limitations included a lack of information regarding minimal residual disease for most patients, particularly among those treated before 2015, as well as no available information on maintenance therapies that patients received after allo-HCT.
“Over time, significant progress in allo-HCT has decreased mortality and allowed for the delivery of allo-HCT to older patients,” Bazarbachi said in the release. “However, little information is available about the global impact of these charges and the predictive factors for post-transplant outcomes, and available data on outcomes from retrospective and prospective studies are mixed.
“We hoped these large-scale, real-world data could serve as a benchmark for future studies in this setting,” he added. “Our study represents one of the largest analyses to date assessing trends over time and predictive factors for outcomes in elderly [patients with] AML after allo-HCT.”
References:
- Outcomes after stem cell transplant in elderly patients with acute myeloid leukemia have improved since 2000 (press release). Available at: https://www.aacr.org/about-the-aacr/newsroom/news-releases/outcomes-after-stem-cell-transplant-in-elderly-patients-with-acute-myeloid-leukemia-have-improved-since-2000/. Published March 22, 2024. Accessed March 22, 2024.
Collapse
Click Here to Manage Email Alerts