Increasing Use of Allogeneic Hematopoietic Cell Transplantation (HCT) in Patients Age 70 Years and Older: A CIBMTR Study of Trends and Outcomes
Bibliographic record
Abstract
Limited data exist regarding the use and outcomes of allogeneic HCT in adults 70 years and older. We aimed to describe trends and outcomes of allogeneic HCT in this population utilizing data reported to the CIBMTR from 2000-2013 from US centers. 1106 allogeneic HCT recipients ≥70 years (89% 70-74, 10% 75-79, <1% ≥80) from 103 centers are included. The most common disease indications were AML (54%), MDS/MPN (22%), and NHL (10%). 82% had KPS ≥80% and 46% had HCT-CI ≥3 (HCT-CI capture began in 2008). Unrelated donor (URD), HLA-identical sibling (MRD), HLA-mismatched relative, and umbilical cord blood (UCB) were utilized in 61%, 26%, 7%, and 6%, respectively; the majority (87%) received reduced intensity conditioning. The absolute number and proportion of allografts for pts ≥70 years rose markedly over the past decade, from 62 (0.4% of all allogeneic HCT) in 2000-2003 to 471 (3.33% of all allogeneic HCT) in 2012-2013. HCT growth was seen mainly for AML and MDS (figure 1). Increase in HCT for MDS occurred after 2010 as transplants started to be covered by CMS. Table 1 and figure 1 display unadjusted 2-year outcomes. Among those transplanted in the recent era of 2008-2013, higher-risk disease (HR=1.25, P= 0.04 for advanced leukemia/MDS relative to early stage) and UCB relative to MRD (HR=2.1, P<0.01) were associated with higher mortality whereas HCT-CI, performance score and other donor sources were not associated with survival. Use of HCT in patients ≥70 years has increased and overall outcomes have improved significantly over the last decade. Research into methods to reduce TRM may further improve outcomes and encourage greater utilization in this age group.Table 1Univariate 2 year outcomes and 95% CI for each time period for patients 70 and older after allogeneic transplant2000-20032004-20072008-20112012-2013P across time periodTRM34 (23-47)35 (27-43)32 (28-37)34 (28-39)0.92Relapse/progr44 (32-57)43 (34-51)35 (30-40)36 (31-41)0.26PFS21 (12-33)22 (16-30)33 (29-37)30 (25-36)0.04OS28 (17-39)26 (19-34)40 (35-44)36 (30-42)0.008TRM, transplant-related mortality; PFS, progression-free survival; OS, overall survival. Open table in a new tab Figure 2OS for allogeneic HCT recipients 70 years and older transplanted between 2000-2007 and 2008-2013.View Large Image Figure ViewerDownload Hi-res image Download (PPT) TRM, transplant-related mortality; PFS, progression-free survival; OS, overall survival.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".