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Bone marrow transplantation in patients aged 45 years and older.

Publication ,  Journal Article
Klingemann, HG; Storb, R; Fefer, A; Deeg, HJ; Appelbaum, FR; Buckner, CD; Cheever, MA; Greenberg, PD; Stewart, PS; Sullivan, KM
Published in: Blood
March 1986

Increasing age has been reported to be a poor prognostic factor for survival after bone marrow transplantation. We evaluated causes of death and frequency and type of complications after marrow grafting in 24 syngeneic and 39 allogeneic recipients who were 45 to 68 years old at the time of transplant. Most patients were in an advanced stage of hematologic malignancy. Among patients given syngeneic transplants, actuarial disease-free survival at 7 years is 20%. The major causes of death were relapse of leukemia and idiopathic interstitial pneumonia. Among allogeneic recipients, 9 (23%) are currently alive, and actuarial disease-free survival at 7 years is 11%. Cytomegalovirus pneumonia and septicemia were the most frequent causes of death. Patients over 50 years of age had the poorest survival rate (1/13), but many of these were transplanted in an advanced stage of their disease. However, among 12 patients transplanted while in remission or at an early stage of their disease, 5 are surviving 65 to 1,160 days after transplantation, with an actuarial survival rate of 22% at 3 years. This is in contrast to those who received their transplant in relapse: 2 out of 20 patients (10%) became long-term survivors, with a probability of survival of 15% at 3 years. The actuarial incidence of grade II through IV acute graft-v-host disease (GVHD) was 30% for allogeneic recipients 45 to 50 years of age. This was not significantly different from the incidence in younger patients. In patients 51 to 62 years of age, the actuarial incidence of acute GVHD was 79%; however, this group included three partially HLA-mismatched transplants. Ten of 15 patients surviving at least 3 months developed chronic GVHD. These results suggest that marrow transplantation is feasible and should be considered in patients over 45 years, especially if recipients are in good clinical condition and are at an early stage of their disease, such as the chronic phase of chronic myelogenous leukemia and preleukemia. For patients more than 50 years of age, allogeneic marrow grafting cannot presently be considered first-line therapy.

Duke Scholars

Published In

Blood

ISSN

0006-4971

Publication Date

March 1986

Volume

67

Issue

3

Start / End Page

770 / 776

Location

United States

Related Subject Headings

  • Transplantation, Isogeneic
  • Transplantation, Homologous
  • Postoperative Complications
  • Middle Aged
  • Male
  • Lung Diseases
  • Liver Diseases
  • Leukemia
  • Immunology
  • Humans
 

Citation

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Klingemann, H. G., Storb, R., Fefer, A., Deeg, H. J., Appelbaum, F. R., Buckner, C. D., … Sullivan, K. M. (1986). Bone marrow transplantation in patients aged 45 years and older. Blood, 67(3), 770–776.
Klingemann, H. G., R. Storb, A. Fefer, H. J. Deeg, F. R. Appelbaum, C. D. Buckner, M. A. Cheever, P. D. Greenberg, P. S. Stewart, and K. M. Sullivan. “Bone marrow transplantation in patients aged 45 years and older.Blood 67, no. 3 (March 1986): 770–76.
Klingemann HG, Storb R, Fefer A, Deeg HJ, Appelbaum FR, Buckner CD, et al. Bone marrow transplantation in patients aged 45 years and older. Blood. 1986 Mar;67(3):770–6.
Klingemann, H. G., et al. “Bone marrow transplantation in patients aged 45 years and older.Blood, vol. 67, no. 3, Mar. 1986, pp. 770–76.
Klingemann HG, Storb R, Fefer A, Deeg HJ, Appelbaum FR, Buckner CD, Cheever MA, Greenberg PD, Stewart PS, Sullivan KM. Bone marrow transplantation in patients aged 45 years and older. Blood. 1986 Mar;67(3):770–776.

Published In

Blood

ISSN

0006-4971

Publication Date

March 1986

Volume

67

Issue

3

Start / End Page

770 / 776

Location

United States

Related Subject Headings

  • Transplantation, Isogeneic
  • Transplantation, Homologous
  • Postoperative Complications
  • Middle Aged
  • Male
  • Lung Diseases
  • Liver Diseases
  • Leukemia
  • Immunology
  • Humans