Stem cell transplants in older patients with acute lymphoblastic leukemia

This study aimed to investigate the outcome for patients aged over 60 who underwent reduced intensity allogeneic stem cell transplant.

This study concluded that a subset of these patients will have extended survival and disease-free state following treatment.

Hematopoietic stem cell transplantation (HSCT) is increasingly being used to treat older patients with acute lymphoblastic leukemia (ALL). HSCT involves taking stem cells from a donor and transplanting them into the patient. These cells can then grow and reproduce to replace cells damaged or destroyed during ALL. There are some concerns surrounding the long-term outcomes of HSCT for older patients. Reduced intensity HSCT involves lower doses of chemotherapy prior to transplant, which may be more tolerable for older patients.

The outcomes for patients aged 60 and over with ALL who were treated with reduced intensity HSCT were unknown.  

This study involved 142 older patients who had ALL. The patients were aged 60 to 76 and received HSCT in first remission. Patients were followed for an average of 36 months post-HSCT.

At 3 years, the overall survival (OS, time from treatment until death from any cause) rate was 42%. At 3 years, the leukemia-free survival rate (time from treatment until leukemia returns) was 35%.

Cytomegalovirus (CMV) donor-recipient matching (CMV D+/R+) was associated with lower OS. This is when both the donor and recipient are CMV positive. CMV is a virus that can cause severe neurological damage in patients with a weakened immune system (such as ALL HSCT patients).

Patients who received a transplant from unrelated donors had were 3.7 times more likely to experience grade II-IV acute graft versus host disease (GVHD) compared to those who received grafts from matched related donors. GVHD is a side effect of transplant. It occurs when the cells that have been transplanted see the body as foreign and begin to attack it.

This study concluded that a subset of patients aged 60 and over with ALL will have extended survival and disease-free state after HSCT treatment.  

Consult your physician about the pros and cons of HSCT as a treatment option.