Age Shouldn't Limit Access to Transplants for MDS,
Comparing recipients who were 60 to 65 with those
over 66, there were no statistically significant differences in overall
2013 - Patients with myelodysplastic syndromes (MDS) who were as old as
74 fared as well with stem cell transplantation as did patients in the
60-to-65 age range, according to a study from Dana-Farber Cancer
Institute presented at the annual meeting of the American Society of
"This is good evidence that age alone should not
limit who should get a transplant for MDS," said
Gregory Abel, MD, MPH, a medical oncologist at Dana-Farber.
"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."
MDS comprises several types of bone marrow failure
causing severe anemia.
Abel, senior author
Edwin P. Alyea, III, MD, and their colleagues analyzed the
Dana-Farber experience over 10 years with reduced-intensity conditioning
"mini-transplants" in patients with MDS, a group of bone-marrow
disorders that generally develop in older adults.
The mean age at diagnosis is 71. Transplantation is
the only potentially curative treatment for MDS in any age group, but
many patients are not healthy enough to undergo the procedure.
The Dana-Farber researchers studied the records of
67 patients ranging in age from 60 to 74. The majority — 64 percent —
received transplants from unrelated donors. Comparing recipients who
were 60 to 65 with those older than 66, there were no statistically
significant differences in overall survival at four years or in
four-year survival without disease progression.
Patients in the two age groups also had comparable
rates of deaths that weren't caused by disease relapse, and in the
cumulative incidence of relapse itself.
In addition, using significant components of the
revised International Prognostic Scoring System (IPSS-R), the authors
created a new risk score to predict four-year overall survival at time
of transplantation. In two multivariable models, one that included the
IPSS-R and another that included the new score, age was not a
significant predictor of overall survival.
The study findings, said Abel, "are good news,
since patients with MDS tend to be elderly and this is the only curative
treatment at the moment for this disease."
"We hope this contributes to a growing body of
evidence that treatment options should not be denied because of advanced
age alone," said Alyea. "This is especially important in the older
patients who have Medicare."
Other authors included Haesook Kim, PhD; Philippe
Armand, MD, PhD; Corey Cutler, MD; Joseph Antin, MD; John Koreth, MBBS,
DPhil; Vincent Ho, MD; and Robert Soiffer, MD, all of Dana-Farber.
Dr. Abel's work was in part supported by a Scholar
in Clinical Research Award from the Leukemia and Lymphoma Society.