Not Too Old for a Stem Cell Transplant

Stem cell transplantation may be an effective treatment for elderly patients with myelodysplastic syndromes

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Age can impact a patient’s treatment options, but when it comes to stem cell transplants, a recent study showed that being old may not be something to be worry about.

Stem cell transplants may be an effective treatment for patients whose body is not able to produce healthy blood cells, as occurs in patients with myelodysplastic syndrome (MDS).

However, stem cell transplants have many risks for complications, and it is important to know whether older patients can benefit from these transplants.

This recent study found that nearly half of patients who underwent stem cell transplants were alive after four years of treatment, regardless of their age.

"Discuss your treatment options with your doctor."

This recent study examined the health outcomes of patients who underwent stem cell transplantation from a donor (allo-HSCT) and was conducted by Gregory A. Abel, MD, MPH, of the Dana-Farber Cancer Institute in Boston, MA, and colleagues.

According to Dr. Abel, “... [P]atients with MDS tend to be elderly and [allo-HSCT] is the only curative treatment at the moment for this disease.”

Dr. Abel and colleagues analyzed data from 67 older MDS patients who underwent allo-HSCT at the Dana-Farber Hospital between 2001 and 2011.

During allo-HSCT, the participants received the following medications: fludarabine (Fludara), busulfan (Busulfex), tacrolimus (Prograf), sirolimus (Rapamune), and in some cases, methotrexate to prevent transplant complications.

The researchers compared data from two groups of patients: those between 60 and 65 years of age versus those between 66 and 74 years.

These researchers found that in 39 percent of the participants, disease state remained steady and didn’t worsen for at least four years after allo-HTC. But 40 percent of the participants had a relapse (return) of their condition during the four-year period.

In addition, the study reported that 47 percent of participants lived at least four years after allo-HSCT. And, 21 percent died even though their disease was controlled (without relapse).

The researchers found similar results when they separated the participants by age group.  

“Calendar age is less important than other measures, such as whether a patient is physically fit enough to get through a transplant, has a lot of comorbidities, and what his or her performance status is,” Dr Abel said in a statement.

At present, the standard criteria used to predict clinical outcomes in patients with MDS is the International Prognostic Scoring System (IPSS-R). However, the researchers reported that for this study, the IPSS-R wasn’t able to accurately predict the four-year survival rate at time of stem cell transplantation. Therefore, they proposed some modifications to the IPSS-R model that predicted better the survival rate of MDS patients. The authors did not find an association between age and the overall survival rate calculated using these two models (IPSS-R and Modified IPSS-R).

Although the new model proposed in this study needs further validation, precisely predicting survival rate in MDS patients at time of transplantation will help to distinguish patients that will likely benefit from allo-HSTC.

"We hope this contributes to a growing body of evidence that treatment options should not be denied because of advanced age alone," said Edwin P. Alyea, III, MD, senior author of this study.

This study was presented on December 7 at the 55th American Society of Hematology Annual Meeting in New Orleans. The authors had no disclosures to make.

Review Date: 
December 11, 2013
Last Updated:
December 12, 2013