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Blood, 15 February 2005, Vol. 105, No. 4, pp. 1810-1814.
Prepublished online as a Blood First Edition Paper on September 30, 2004; DOI 10.1182/blood-2004-05-1947.
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Submitted May 25, 2004
Accepted September 1, 2004
Comparative outcome of non-myeloablative and myeloablative allogeneic hematopoietic cell transplantation for patients greater than fifty years of age
Edwin P Alyea*, Haesook T Kim, Vincent T Ho, Corey Cutler, John Gribben, Daniel J DeAngelo, Stephanie J Lee, Sarah Windawi, Jerome Ritz, Richard M Stone, Joseph H Antin, and Robert J Soiffer
Departments of Medical Oncology and Biostatistical Science, Dana-Farber Cancer Institute, Boston, MA, USA
* Corresponding author; email: edwin_alyea{at}dfci.harvard.edu.
Non-myeloablative stem cell transplantation (NST) is increasingly utilized in older patients. The impact of the shift from myeloablative to NST upon relapse, transplant complications, and outcome has yet to be fully examined. We performed a retrospective analysis of 152 patients older than age 50 receiving NST or myeloablative transplantation. 71 patients received non-myeloablative conditioning, fludarabine (30 mg/m2/day x 4) and intravenous busulfan (0.8 mg/kg/d x 4). 81 patients received myeloablative conditioning, primarily cyclophosphamide and TBI. NST patients were more likely to have unrelated donors (58% vs 36%, p=0.009), prior transplant (25% vs 4%, p=<0.0001), and active disease at transplantation (85% vs. 59%, p=<0.001). Despite the adverse characteristics, overall survival was improved in the NST group at 1 (51% vs 39%) and 2 (39% vs. 29%) years (p = 0.056). There was no difference in progression free survival (2 year, 27% vs. 25%, p =0.24). Incidence of 2-4 GVHD was similar, (28% vs. 27%). Non-relapse mortality was lower for NST patients (32% vs. 50%, p=0.01), but relapse was higher (46% vs. 30%, p=0.052). Our experience suggests that, in patients over age 50, NST with fludarabine and low dose busulfan leads to an overall outcome at least as good as myeloablative therapy.
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