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Outcomes in older vs younger patients undergoing PBSCT with PTCy
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The use of post-transplant cyclophosphamide (PTCy) as GvHD prophylaxis allows for haploidentical PBSCT to have similar outcomes to HLA-matched transplant.1 However, there are limited data on the safety of haploidentical transplant in older patients.1 A retrospective study analyzed data from 121 adult patients with hematologic malignancies who underwent PBSCT with PTCy at the Moffitt Cancer Center between December 11, 2014, and October 12, 2019.1 Patients were categorized into two age groups: older patients, ≥60 years (n = 55) and younger patients, <60 years (n = 66). Results were published by Adoncecchi et al.1 in Cancers. |
| Key learnings |
| At 2 years, despite a worse cumulative incidence of NRM in older patients vs younger patients (22% vs 14%, p = 0.008), rates of cGvHD (56% vs 67%; p = 0.196), OS (66% vs 59%; p = 0.916), and DFS (53% vs 51%; p = 0.72) were comparable. |
| Hematopoietic comorbidity index (HCT-CI) ≥ 3 was associated with worse DFS (HR, 1.87; 95% CI, 1.04–3.34; p = 0.035) and OS (HR, 1.98; 95% CI, 1.03–3.84, p = 0.042). |
| There was a trend toward improved 2-year OS in older patients receiving a Flu/Cy/TBI vs Flu/Bu conditioning regimen (71% vs 53%; p = 0.121). However, the incidence of relapse was higher with Flu/Cy/TBI vs Flu/Bu (41% vs 11%; p =0.156). |
| This study suggests that haploidentical PBSCT with PTCy is appropriate for older patients, and that optimization of conditioning regimen and post-transplant care can improve outcomes. Individualized risk assessment focusing on comorbidities and disease risk should guide treatment decisions. |
Abbreviations: Bu, Busulfan; cGvHD, chronic graft-versus-host disease; Cy, cyclophosphamide; Flu, fludarabine; GvHD, graft-versus-host disease; NRM, non-relapse mortality; OS, overall survival; PBSCT, peripheral blood stem cell transplantation; PTCy, post-transplant cyclophosphamide; SHR, sub-distribution hazard ratio; TBI, total body irradiation.
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