Outcomes of two-step haploidentical allogeneic stem cell transplantation in elderly patients with hematologic malignancies
Older patients are disproportionally affected by HM and are more likely to have worse outcomes due to adverse disease biology, poor performance status, and existing medical comorbidities. Allogenic hematopoietic stem cell transplantation remains the only curative option and offers the most potential for long-term disease control for many HM.
Allogeneic hematopoietic stem cell transplantation (allo-SCT) remains the best curative option for the majority of patients with hematologic malignancies (HM); however, many elderly patients are excluded from transplant and outcome data in this population is still limited.
The novel two-step graft engineering approach has been the main platform for allo-SCT at Thomas Jefferson University since 2006. Following administration of the preparative regimen, we infuse donor lymphocytes, followed by cyclophosphamide to induce bidirectional tolerance, then infusion of CD34-selected cells.
A total of 76 patients≥65 years old with HM underwent haploidentical (haplo) allo-SCT on the two-step transplant platform between 2007 and 2021. The median time to neutrophil engraftment was 11 days and platelet engraftment was 18 days. With a median follow up of 44 months, the 3-year overall survival (OS) and progression-free survival (PFS) were 36.3% and 35.6%, respectively.
The two-step haplo allo-SCT is a novel alternative platform for high-risk older HM patients, achieving fast engraftment, low relapse rates. and promising survival.
Bi, X., Gergis, U., Wagner, J.L. et al. Outcomes of two-step haploidentical allogeneic stem cell transplantation in elderly patients with hematologic malignancies. Bone Marrow Transplant (2022). https://doi.org/10.1038/s41409-022-01780-w
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