Allogeneic hematopoietic stem cell transplantation in patients aged 60-79 years in Germany (1998-2018): a registry study

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Jan Frederic Weller - , University Hospital Tübingen (Author)
  • Claudia Lengerke - , University Hospital Tübingen (Author)
  • Jürgen Finke - , University Medical Center Freiburg (Author)
  • Johannes Schetelig - , Department of internal Medicine I, University Vascular Centre (Author)
  • Uwe Platzbecker - , University Hospital Leipzig (Author)
  • Hermann Einsele - , University Hospital of Würzburg (Author)
  • Thomas Schroeder - , LVR University Hospital Essen (Author)
  • Christoph Faul - , University Hospital Tübingen (Author)
  • Matthias Stelljes - , University Hospital Münster (Author)
  • Peter Dreger - , National Center for Tumor Diseases (NCT) Heidelberg (Author)
  • Igor W Blau - , Charité – Universitätsmedizin Berlin (Author)
  • Gerald Wulf - , University Medical Center Göttingen (Author)
  • Johanna Tischer - , Hospital of the Ludwig-Maximilians-University (LMU) Munich (Author)
  • Christoph Scheid - , Uniklinik Köln (Author)
  • Ahmet Elmaagacli - , Asklepios Klinik St. Georg (Author)
  • Helga Neidlinger - , German Registry for Stem Cell Transplantation (Author)
  • Sarah Flossdorf - , German Registry for Stem Cell Transplantation (Author)
  • Martin Bornhäuser - , Department of internal Medicine I, University Cancer Centre, University Vascular Centre (Author)
  • Wolfgang Bethge - , University Hospital Tübingen (Author)
  • Katharina Fleischhauer - , German Registry for Stem Cell Transplantation (Author)
  • Nicolaus Kröger - , German Registry for Stem Cell Transplantation (Author)
  • Liesbeth C De Wreede - , Leiden University (Author)
  • Maximilian Christopeit - , University Hospital Tübingen (Author)

Abstract

Incidences of diseases treated with transplantation frequently peak at higher age. The contribution of age to total risk of transplantation has not been estimated amidst an aging society. We compare outcomes of 1,547 patients aged 70-79 and 9,422 patients aged 60-69 transplanted 1998-2018 for myeloid, lymphoid and further neoplasia in Germany. To quantify the contribution of population mortality to survival, we derive excess mortality based on a sex-, year- and age-matched German population in a multistate model that incorporates relapse and graft-versus-host-disease (GvHD). Overall, relapse-free (RFS) and GvHD-free-relapse-free survival (GRFS) is inferior in patients 70-79, compared to patients 60-69, with 36% [95%CI 34-39%] versus 43% [41-44%], 32% [30-35%] versus 36% [35-37%] and 23% [21-26%] versus 27% [26-28%] three years post-transplant (p<0.001). Cumulative incidences of relapse at three years are 27% [25-30%] (patients 70-79) versus 29% [29-30%] (60-69, p=0.71), yet the difference in non-relapse mortality (NRM, 40% [38-43%] versus 35% [34-36%] in 70-79 versus 60-69 aged patients, p<0.001) translates into survival differences. Median OS of patients surviving >1 year relapse-free is 6.7 (median, 95%CI 4.5-9.4, 70-79) versus 9 (8.4-10.1, 60-69) years since landmark. Three years after RFS of 1 year, excess NRM is 14% [95%CI 12-18%] in 70-79 versus 12% [11-13%] in 60-69, while population NRM is 7% [6-7%] versus 3% [3-3%]. Mortality for reasons other than relapse, GvHD or age is as high as 27% [24-29%] and 22% [22-23%] 4 years after transplantation. In conclusion, survival amongst older patients is adequate after allogeneic stem cell transplantation.

Details

Original languageEnglish
JournalHaematologica
Publication statusE-pub ahead of print - 31 Aug 2023
Peer-reviewedYes

External IDs

unpaywall 10.3324/haematol.2023.283175
Scopus 85184148675

Keywords