GITMO Registry Study on Allogeneic Transplantation in Patients Aged ≥60 Years from 2000 to 2017: Improvements and Criticisms
Michele Malagola, Nicola Polverelli, Vicky Rubini, Massimo Martino, Francesca Patriarca, Benedetto Bruno, Luisa Giaccone, Giovanni Grillo, Stefania Bramanti, Paolo Bernasconi, Marco De Gobbi, Annalisa Natale, Elisabetta Terruzzi, Attilio Olivieri, Patrizia Chiusolo, Angelo Michele Carella, Marco Casini, Chiara Nozzoli, Patrizio Mazza, Simona Bassi, Francesco Onida, Adriana Vacca, Sadia Falcioni, Mario Luppi, Anna Paola Iori, Vincenzo Pavone, Cristina Skert, Paola Carluccio, Carlo Borghero, Anna Proia, Carmine Selleri, Nicoletta Sacchi, Sonia Mammoliti, Elena Oldani, Fabio Ciceri, Domenico Russo, Francesca Bonifazi, Michele Malagola, Nicola Polverelli, Vicky Rubini, Massimo Martino, Francesca Patriarca, Benedetto Bruno, Luisa Giaccone, Giovanni Grillo, Stefania Bramanti, Paolo Bernasconi, Marco De Gobbi, Annalisa Natale, Elisabetta Terruzzi, Attilio Olivieri, Patrizia Chiusolo, Angelo Michele Carella, Marco Casini, Chiara Nozzoli, Patrizio Mazza, Simona Bassi, Francesco Onida, Adriana Vacca, Sadia Falcioni, Mario Luppi, Anna Paola Iori, Vincenzo Pavone, Cristina Skert, Paola Carluccio, Carlo Borghero, Anna Proia, Carmine Selleri, Nicoletta Sacchi, Sonia Mammoliti, Elena Oldani, Fabio Ciceri, Domenico Russo, Francesca Bonifazi
Abstract
Today, allogeneic stem cell transplantation (allo-SCT) can be offered to patients up to age 70 to 72 years and represents one of the most effective curative treatments for many hematologic malignancies. The primary objective of the study was to collect data from the allo-SCTs performed in Italy between 2000 and 2017 in patients aged ≥60 years to evaluate the changes in safety and efficacy outcomes, as well as their distribution and characteristics over time. The Italian Group for Bone Marrow Transplantation, Hematopoietic Stem Cells and Cell Therapy (GITMO) AlloEld study (ClinicalTrials.gov identifier NCT04469985) is a retrospective analysis of allo-SCTs performed at 30 Italian transplantation centers in older patients (age ≥60 years) between 2000 and 2017 (n = 1996). For the purpose of this analysis, patients were grouped into 3 time periods: time A, 2000 to 2005 (n = 256; 12%); time B, 2006 to 2011 (n = 584; 29%); and time C, 2012 to 2017 (n = 1156; 59%). After a median follow-up of 5.6 years, the 5-year nonrelapse mortality (NRM) remained stable (time A, 32.8%; time B, 36.2%; and time C, 35.0%; P = .5), overall survival improved (time A, 28.4%; time B, 31.8%; and time C, 37.3%; P = .012), and the cumulative incidence of relapse was reduced (time A, 45.3%; time B, 38.2%; time C, 30.0%; P < .0001). The 2-year incidence of extensive chronic graft-versus-host disease was reduced significantly (time A, 17.2%; time B, 15.8%; time C, 12.2%; P = .004). Considering times A and B together (2000 to 2011), the 2-year NRM was positively correlated with the Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score; NRM was 25.2% in patients with an HCT-CI score of 0, 33.9% in those with a score of 1 or 2, and 36.1% in those with a score of 3 (P < .001). However, after 2012, the HCT-CI score was not significantly predictive of NRM. This study shows that the transplantation procedure in elderly patients became more effective over time. Relapse incidence remains the major problem, and strategies to prevent it are currently under investigation (eg, post-transplantation maintenance). The selection of patients aged ≥60 could be improved by combining HCT-CI and frailty assessment to better predict NRM.
Keywords: Allogeneic stem cell transplantation; Comorbidities; Elderly; Frailty.
Copyright © 2021 The American Society for Transplantation and Cellular Therapy. Published by Elsevier Inc. All rights reserved.
Source: PubMed