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. 2023 Feb;64(2):123-132.
doi: 10.3349/ymj.2022.0331.

Clinical Experience of Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients Aged 60 Years and Older in South Korea

Young Sok Ji #  1 , Jae-Sook Ahn #  2 , Jina Yun  1 , Geum Ha Jang  1 , Sung Hee Lim  1 , Se Hyung Kim  1 , Chan Kyu Kim  1 , Jong Ho Won  3 , Seong Kyu Park  4
Affiliations

Clinical Experience of Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients Aged 60 Years and Older in South Korea

Young Sok Ji et al. Yonsei Med J. 2023 Feb.

Abstract

Purpose: The purpose of this study is to share our outcomes and experiences on allogeneic hematopoietic stem cell transplantation (HSCT) in elderly patients aged 60 years and older with myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) in South Korea, and to compare them with other studies.

Materials and methods: We analyzed the clinical outcomes of 116 patients with AML or MDS aged 60 years and older who underwent allogeneic HSCT. We also analyzed which pretreatment factors affect the overall survival (OS) after allogeneic HSCT.

Results: Neutrophil and platelet engraftment were achieved at median day +11 [interquartile range (IQR) 10-15] and +14 (IQR 11-19), respectively. A complete donor chimerism was confirmed in 65 (56.0%) patients at 3 weeks and in 63 (54.3%) patients at 3 months after HSCT. The estimated incidence of grade II-IV acute graft-versus-host disease (GVHD) at day 100 was 13.7%. The estimated incidence of chronic GVHD at 2 years was 38.8%. Within a median follow-up of 14 months after HSCT, OS was 64% at 1 year and 55% at 2 years, and non-relapse mortality (NRM) was 20% at 1 year and 28% at 2 years. Multivariate analysis revealed that male sex and Hematopoietic Cell Transplantation-Specific Comorbidity Index ≥3 were associated with poor OS.

Conclusion: This study showed that allogeneic HSCT in elderly adults aged 60 and older can be performed with successful engraftment and acceptable NRM and OS are expected given the generally known survival of patients with higher risk MDS and poor risk AML.

Keywords: Asia; Myelodysplastic syndrome; acute myeloid leukemia; aged; hematopoietic stem cell transplantation.

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Conflict of interest statement

The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Estimated cumulative incidence of GVHD and relapse. (A) Acute GVHD, all grades. (B) Acute GVHD, grade II–IV. (C) Chronic GVHD. (D) Relapse. GVHD, graft-versus-host disease.
Fig. 2
Fig. 2. OS and NRM of patients receiving allogeneic hematopoietic stem cell transplantation. (A) OS. (B) NRM. (C) OS according to type of disease. (D) NRM according to type of disease. OS, overall survival; NRM, non-relapse mortality; AML, acute myeloid leukemia; MDS, myelodysplastic syndrome.
Fig. 3
Fig. 3. NRM and OS according to sex and HCT-CI. (A) NRM according to sex. (B) OS according to sex. (C) NRM according to HCT-CI. (D) OS according to HCT-CI. (E) Estimated cumulative incidence of relapse according to sex. (F) Estimated cumulative incidence of relapse according to HCT-CI. OS, overall survival; NRM, non-relapse mortality; HCT-CI, hematopoietic cell transplantation-specific comorbidity index.
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