Elderly patients undergoing allogeneic hematopoietic stem cell transplantation (HCT) for myelodysplastic syndrome (MDS) do not have significantly different outcomes compared with younger patients, according to research published in JAMA Oncology.
Of the 15,000 patients in the United States diagnosed with MDS annually, 80% are older than 65 years, with an incidence of 22.8 per 100,000 people over 70 years old. Although HCT is the only curative option for patients with MDS, elderly patients often do not receive this treatment.
Although previous research has suggested that age does not affect outcomes after HCT in patients up to 70 years old, in 2010, the US Centers for Medicare & Medicaid Services concluded that data supporting HCT use in the elderly patient group are insufficient. Reasons for underuse of HCT in elderly patients with MDS include patient comorbidities, physician reluctance, refusal by third-party payers, arbitrary age limits set by transplant centers, and patient concerns.
The Center for International Bone Marrow Transplant Research initiated a study to determine whether HCT outcomes differ between those aged 55 to 64 years and those 65 years or older. Patients were enrolled between December 2010 and May 2014.
Of 1280 patients included in this study, 592 were aged 55 to 64 years, and 688 were 65 years or older; all other characteristics were balanced between the groups. Overall survival after 3 years, the study’s primary end point, was 42% in the younger patient group compared with 37% among the older patients (hazard ratio, 1.09; P =.23).
Nonrelapse mortality was similar in the 2 groups, at 28% in the older patient group compared with 25% in the younger patient group.
The “findings of this study suggest that chronologic age alone should not be used as a determinant for transplant consideration,” the authors wrote. “Based on current data, we would recommend coverage of HCT for MDS by the US Centers for Medicare & Medicaid Services.”
1. Atallah E, Logan B, Chen M, et al. Comparison of patient age groups in transplantation for myelodysplastic syndrome: The Medicare Coverage With Evidence Development Study [published online December 12, 2019]. JAMA Oncol. doi:10.1001/jamaoncol.2019.5140