Advances in Conditioning Regimens for Older Adults Undergoing Allogeneic Stem Cell Transplantation to Treat Hematologic Malignancies
- 4 April 2013
- journal article
- review article
- Published by Springer Science and Business Media LLC in Drugs & Aging
- Vol. 30 (6), 373-381
- https://doi.org/10.1007/s40266-013-0076-x
Abstract
Allogeneic stem cell transplantation (SCT) is a potentially curative treatment for patients with hematological malignancies. These diseases, however, have their peak incidence in the sixth to eighth decades of life. Historically, elderly patients have been considered unsuitable candidates for SCT because of high treatment-related mortality (TRM). Over the past 15 years, the use of reduced-intensity conditioning (RIC) regimens before SCT has allowed patients in the sixth and seventh decades of life to be routinely transplanted. Despite major differences among transplant centers in the intensity and composition of the conditioning regimen and immunosuppression, choice of graft source, postgraft immunomodulation, and supportive care, there has been a dramatic decrease in TRM, allowing safer delivery of SCT. Major obstacles to SCT in elderly patients include donor availability, graft-versus-host disease, delayed immune recovery, multiple comorbidities, and chemo refractoriness. Here we review the current results of SCT in elderly patients, focusing on the role of RIC, and using myeloid diseases as the model for discussion.Keywords
This publication has 71 references indexed in Scilit:
- Similar outcomes using myeloablative vs reduced-intensity allogeneic transplant preparative regimens for AML or MDSBone Marrow Transplantation, 2012
- Anti-T Cell Antibodies as Part of the Preparative Regimen in Hematopoietic Cell Transplantation—A DebateTransplantation and Cellular Therapy, 2012
- Long-term Outcomes Among Older Patients Following Nonmyeloablative Conditioning and Allogeneic Hematopoietic Cell Transplantation for Advanced Hematologic MalignanciesJama-Journal Of The American Medical Association, 2011
- Alternative donor transplantation after reduced intensity conditioning: results of parallel phase 2 trials using partially HLA-mismatched related bone marrow or unrelated double umbilical cord blood graftsBlood, 2011
- Impact of immune modulation with anti–T-cell antibodies on the outcome of reduced-intensity allogeneic hematopoietic stem cell transplantation for hematologic malignanciesBlood, 2011
- Conditioning with Treosulfan and Fludarabine followed by Allogeneic Hematopoietic Cell Transplantation for High-Risk Hematologic MalignanciesTransplantation and Cellular Therapy, 2011
- Reduced-Intensity Conditioning Regimen Workshop: Defining the Dose Spectrum. Report of a Workshop Convened by the Center for International Blood and Marrow Transplant ResearchTransplantation and Cellular Therapy, 2009
- Reduced-Intensity Allogeneic Transplant in Patients Older Than 55 Years: Unrelated Umbilical Cord Blood Is Safe and Effective for Patients without a Matched Related DonorTransplantation and Cellular Therapy, 2008
- Hematopoietic cell transplantation–specific comorbidity index as an outcome predictor for patients with acute myeloid leukemia in first remission: combined FHCRC and MDACC experiencesBlood, 2007
- Prognostic impact of elevated pretransplantation serum ferritin in patients undergoing myeloablative stem cell transplantationBlood, 2007