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1دورية أكاديمية
المؤلفون: Oran, Betül, Ahn, Kwang Woo, Fretham, Caitrin, Beitinjaneh, Amer, Bashey, Asad, Pawarode, Attaphol, Wirk, Baldeep, Scott, Bart L, Savani, Bipin N, Bredeson, Christopher, Weisdorf, Daniel, Marks, David I, Rizzieri, David, Copelan, Edward, Hildebrandt, Gerhard C, Hale, Gregory A, Murthy, Hemant S, Lazarus, Hillard M, Cerny, Jan, Liesveld, Jane L, Yared, Jean A, Yves-Cahn, Jean, Szer, Jeffrey, Verdonck, Leo F, Aljurf, Mahmoud, van der Poel, Marjolein, Litzow, Mark, Kalaycio, Matt, Grunwald, Michael R, Diaz, Miguel Angel, Sabloff, Mitchell, Kharfan-Dabaja, Mohamed A, Majhail, Navneet S, Farhadfar, Nosha, Reshef, Ran, Olsson, Richard F, Gale, Robert Peter, Nakamura, Ryotaro, Seo, Sachiko, Chhabra, Saurabh, Hashmi, Shahrukh, Farhan, Shatha, Ganguly, Siddhartha, Nathan, Sunita, Nishihori, Taiga, Jain, Tania, Agrawal, Vaibhav, Bacher, Ulrike, Popat, Uday, Saber, Wael
المصدر: Hematology/Oncology Articles
الوصف: Reduced-intensity conditioning (RIC) regimens developed to extend allogeneic stem cell transplantation (HSCT) to older patients have resulted in encouraging outcomes. We aimed to compare the two most commonly used RIC regimens, intravenous use of fludarabine with busulfan (FluBu) and fludarabine with melphalan (FluMel), in myelodysplastic syndrome (MDS). Through CIBMTR, we identified 1045 MDS patients aged ≥ 60 years who underwent first HSCT with a matched related or matched (8/8) unrelated donor using RIC. CIBMTR's definition of RIC was used: a regimen that incorporated an intravenous busulfan total dose ≤ 7.2 mg/kg, or a low-dose melphalan total dose of ≤ 150 mg/m(2). The two groups, FluBu (n=697) and FluMel (n=448), were comparable for disease and transplant-related characteristics except for the more frequent use of anti-thymocyte globulin or alemtuzumab in the FluBu group (39% vs. 31%). The median age was 67 in both groups. FluMel was associated with a reduced relapse incidence (RI) compared with FluBu, with a 1-year adjusted incidence of 26% vs. 44% (p≤0.0001). Transplant-related mortality (TRM) was higher with FluMel compared with FluBu (26% vs. 16%, p≤0.0001). Since the magnitude of improvement with FluMel in RI was greater than the improvement in TRM with FluBu, disease-free survival (DFS) was improved at 1-year and beyond with FluMel compared with FluBu (48% vs. 40% at 1 year, p=0.02, and 35% vs. 27% at 3 years, p=0.01). Overall survival (OS) was comparable at 1 year (63% vs. 61%, p=0.4) but significantly improved with FluMel compared with FluBu at 3 years (46% vs. 39%, p=0.03). Our results suggest that FluMel is associated with superior DFS compared with FluBu due to reduced RI in older MDS patients.
العلاقة: https://scholarlycommons.henryford.com/hematologyoncology_articles/202Test; http://libkey.io/34403791Test
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2دورية أكاديمية
المؤلفون: Muffly, Lori, Pasquini, Marcelo C, Martens, Michael, Brazauskas, Ruta, Zhu, Xiaochun, Adekola, Kehinde, Aljurf, Mahmoud, Ballen, Karen K, Bajel, Ashish, Baron, Frederic, Battiwalla, Minoo, Beitinjaneh, Amer, Cahn, Jean-Yves, Carabasi, Mathew, Chen, Yi-Bin, Chhabra, Saurabh, Ciurea, Stefan, Copelan, Edward, D'Souza, Anita, Edwards, John, Foran, James, Freytes, Cesar O, Fung, Henry C, Gale, Robert P, Giralt, Sergio, Hashmi, Shahrukh K, Hildebrandt, Gerhard C, Ho, Vincent, Jakubowski, Ann, Lazarus, Hillard, Luskin, Marlise R, Martino, Rodrigo, Maziarz, Richard, McCarthy, Philip, Nishihori, Taiga, Olin, Rebecca, Olsson, Richard F, Pawarode, Attaphol, Peres, Edward, Rezvani, Andrew R, Rizzieri, David, Savani, Bipin N, Schouten, Harry C, Sabloff, Mitchell, Seftel, Matthew, Seo, Sachiko, Sorror, Mohamed L, Szer, Jeff, Wirk, Baldeep M, Wood, William A, Artz, Andrew
المصدر: Hematology/Oncology Articles
مصطلحات موضوعية: Aged, Cohort Studies, Demography, Female, Hematopoietic Stem Cell Transplantation, Humans, Male, Multivariate Analysis, Prognosis, Time Factors, Transplantation, Homologous, Treatment Outcome, United States
الوصف: In this study, we evaluated trends and outcomes of allogeneic hematopoietic cell transplantation (HCT) in adults ≥70 years with hematologic malignancies across the United States. Adults ≥70 years with a hematologic malignancy undergoing first allogeneic HCT in the United States between 2000 and 2013 and reported to the Center for International Blood and Marrow Transplant Research were eligible. Transplant utilization and transplant outcomes, including overall survival (OS), progression-free survival (PFS), and transplant-related mortality (TRM) were studied. One thousand one hundred and six patients ≥70 years underwent HCT across 103 transplant centers. The number and proportion of allografts performed in this population rose markedly over the past decade, accounting for 0.1% of transplants in 2000 to 3.85% (N = 298) in 2013. Acute myeloid leukemia and myelodysplastic syndromes represented the most common disease indications. Two-year OS and PFS significantly improved over time (OS: 26% [95% confidence interval (CI), 21% to 33%] in 2000-2007 to 39% [95% CI, 35% to 42%] in 2008-2013, P < .001; PFS: 22% [16% to 28%] in 2000-2007 to 32% [95% CI, 29% to 36%] in 2008-2013, P = .003). Two-year TRM ranged from 33% to 35% and was unchanged over time (P = .54). Multivariable analysis of OS in the modern era of 2008-2013 revealed higher comorbidity by HCT comorbidity index ≥3 (hazard ratio [HR], 1.27; P = .006), umbilical cord blood graft (HR, 1.97; P = .0002), and myeloablative conditioning (HR, 1.61; P = .0002) as adverse factors. Over the past decade, utilization and survival after allogeneic transplant have increased in patients ≥70 years. Select adults ≥70 years with hematologic malignancies should be considered for transplant.
العلاقة: https://scholarlycommons.henryford.com/hematologyoncology_articles/45Test; http://sfxhosted.exlibrisgroup.com/hfhs?sid=Entrez:PubMed&id=pmid:28674027Test
