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Impact of age on outcomes after bone marrow transplantation for acquired aplastic anemia using HLA-matched sibling donors.

Abstract：

BACKGROUND:Transplantation from an HLA-matched sibling is the treatment of choice for young patients with acquired severe aplastic anemia. For older patients, the acceptable upper age limit for transplantation as first-line treatment varies. The current analysis, therefore, sought to identify age or ages at transplantation at which survival differed. DESIGN AND METHODS:We studied the effect of patients' age, adjusting for other significant factors affecting outcomes, in 1307 patients with severe aplastic anemia after HLA-matched sibling transplantation using logistic and Cox regression analysis. Age categories (<20 years, 20-40 years, >40 years) were determined using Martingale residual plots for overall survival and categories based on differences in survival. RESULTS:Patients aged over 40 years old were more likely to have had immunosuppressive therapy, a poor performance score and a longer interval between diagnosis and transplantation. Neutrophil recovery was similar in all age groups but patients aged over 40 years had a lower likelihood of platelet recovery compared to patients aged less than 20 years (OR 0.45, P=0.01) but not compared to those aged 20-40 years (OR 0.60, P=0.10). Compared to the risk of mortality in patients aged less than 20 years, mortality risks were higher in patients over 40 years old (RR 2.70, P<0.0001) and in those aged 20-40 years (RR 1.69, P<0.0001). The mortality risk was also higher in patients aged over 40 years than in those 20-40 years old (RR 1.60, P=0.008). CONCLUSIONS:Mortality risks increased with age. Risks were also higher in patients with a poor performance score and when the interval between diagnosis and transplantation was longer than 3 months, implying earlier referral would be appropriate when this treatment option is being considered.

journal_name

Haematologica

journal_title

Haematologica

authors

Gupta V,Eapen M,Brazauskas R,Carreras J,Aljurf M,Gale RP,Hale GA,Ilhan O,Passweg JR,Ringdén O,Sabloff M,Schrezenmeier H,Socié G,Marsh JC

doi

10.3324/haematol.2010.026682

subject

Has Abstract

pub_date

2010-12-01 00:00:00

pages

2119-25

issue

eissn

0390-6078

issn

1592-8721

pii

haematol.2010.026682

journal_volume

pub_type

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Impact of age on outcomes after bone marrow transplantation for acquired aplastic anemia using HLA-matched sibling donors.