Umbilical Cord Blood Transplantation after Reduced-Intensity Conditioning for Elderly Patients with Hematologic Diseases

• Published in: Biology of blood and marrow transplantation Vol. 14; no. 5; pp. 583 - 590
• Main Authors: Uchida, Naoyuki, Wake, Atsushi, Takagi, Shinsuke, Yamamoto, Hisashi, Kato, Daisuke, Matsuhashi, Yoshiko, Matsumura, Tomoko, Seo, Sachiko, Matsuno, Naofumi, Masuoka, Kazuhiro, Kusumi, Eiji, Yuji, Koichiro, Miyakoshi, Shigesaburo, Matsuzaki, Michio, Yoneyama, Akiko, Taniguchi, Shuichi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2008
• Subjects: Aged; Aged, 80 and over; Cause of Death; Cord Blood Stem Cell Transplantation - methods; Cord Blood Stem Cell Transplantation - mortality; Cord blood transplantation; Elderly patients; Female; Graft vs Host Disease; Hematologic diseases; Hematologic Diseases - therapy; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; Prognosis; Reduced intensity; Survival Analysis; Transplantation Conditioning - methods; Transplantation, Homologous; Treatment Outcome; Reduced intensity; Hematologic diseases; Elderly patients; Cord blood transplantation
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2008.03.003

Abstract Although allogeneic hematopoietic stem cell transplantation is a potentially curative approach for advanced hematologic diseases, its application to elderly people is limited because of their comorbid physical conditions and lower chance of finding suitable related donors. Umbilical cord blood transplantation with reduced-intensity pretransplant conditioning (RI-UCBT) is 1 way to avoid these obstacles. We analyzed elderly patients aged 55 years and older with hematologic diseases who underwent RI-UCBT at our institute to assess feasibility and effectiveness of this treatment approach. Among the 70 patients included, 50 died, 74% of them from nonrelapse causes. Infection was the primary cause of death. Estimated overall survival and progression-free survival at 2 years were both 23%. In multivariate analyses, standard-risk diseases, age younger than 61 years, grade 0-II acute graft-versus-host disease, and the absence of preengraftment immune reaction were significantly associated with better overall survival. RI-UCBT is a potentially curative and applicable approach for elderly patients. Higher mortality, especially from nonrelapse causes, is the biggest problem to be solved to increase the feasibility of this approach.