Allogeneic hematopoietic stem cell transplantation in patients aged 60-79 years in Germany (1998-2018): a registry study
Jan Frederic Weller,
Claudia Lengerke,
Jürgen Finke,
Johannes Schetelig,
Uwe Platzbecker,
Hermann Einsele,
Thomas Schroeder,
Christoph Faul,
Matthias Stelljes,
Peter Dreger,
Igor W. Blau,
Gerald Wulf,
Johanna Tischer,
Christoph Scheid,
Ahmet Elmaagacli,
Helga Neidlinger,
Sarah Flossdorf,
Martin Bornhäuser,
Wolfgang Bethge,
Katharina Fleischhauer,
Nicolaus Kröger,
Liesbeth C. de Wreede,
Maximilian Christopeit
Affiliations
Jan Frederic Weller
Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen
Claudia Lengerke
Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen
Jürgen Finke
University Medical Center Freiburg, Department of Hematology, Oncology and Stem Cell Transplantation, Faculty of Medicine, University of Freiburg, Freiburg
Johannes Schetelig
Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden
Uwe Platzbecker
Medical Clinic and Policlinic I, Hematology and Cellular Therapy, Leipzig University Hospital, Leipzig
Hermann Einsele
Department of Internal Medicine II, University Hospital of Würzburg, Würzburg
Thomas Schroeder
Department of Hematology and Stem Cell Transplantation, West German Cancer Center Essen, University Hospital Essen, Essen
Christoph Faul
Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen
Matthias Stelljes
Department of Medicine A, University Hospital of Münster, Münster
Peter Dreger
Department of Medicine V, University of Heidelberg, Heidelberg
Igor W. Blau
Medical Clinic, Charité University Medicine Berlin, Berlin
Gerald Wulf
Hematology and Medical Oncology, University Medicine Göttingen, Göttingen
Johanna Tischer
Internal Medicine III, Hematology/ Oncology/ Stem Cell Transplantation, Ludwig-Maximilians-University, Munich
Christoph Scheid
Faculty of Medicine and Cologne University Hospital, Center for Integrated Oncology Aachen-Bonn-Cologne-Düsseldorf (CIO ABCD), University of Cologne, Cologne
Ahmet Elmaagacli
Department of Hematology/Oncology and Stem Cell Transplantation, Asklepios Klinik St. Georg, Hamburg
Helga Neidlinger
German Registry for Stem Cell Transplantation, DRST, Ulm
Sarah Flossdorf
German Registry for Stem Cell Transplantation, DRST, Ulm, Germany; Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University of Duisburg-Essen, Essen
Martin Bornhäuser
Department of Internal Medicine I, University Hospital Carl Gustav Carus, TU Dresden, Dresden
Wolfgang Bethge
Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen
Katharina Fleischhauer
German Registry for Stem Cell Transplantation, DRST, Ulm, Germany; Institute for Experimental Cellular Therapy, University Hospital Essen, Essen
Nicolaus Kröger
German Registry for Stem Cell Transplantation, DRST, Ulm, Germany; Department of Stem Cell Transplantation, University Medical Center Eppendorf, Hamburg
Liesbeth C. de Wreede
Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands; DKMS Clinical Trials Unit, Dresden
Maximilian Christopeit
Department of Internal Medicine II, Hematology, Oncology, Clinical Immunology and Rheumatology, University Hospital Tübingen, Tübingen
Incidences of diseases treated with transplantation frequently peak at higher age. The contribution of age to total risk of transplantation has not been estimated amidst an aging society. We compare outcomes of 1,547 patients aged 70-79 years and 9,422 patients aged 60-69 years transplanted 1998-2018 for myeloid, lymphoid and further neoplasia in Germany. To quantify the contribution of population mortality to survival, we derive excess mortality based on a sex-, year- and agematched German population in a multistate model that incorporates relapse and graft-versus-host-disease (GvHD). Overall survival, relapse-free survival (RFS) and GvHD-free-relapse-free survival (GRFS) is inferior in patients aged 70-79 years, compared to patients aged 60-69 years, with 36% (95% Confidence Interval [CI]: 34-39%) versus 43% (41-44%), 32% (30- 35%) versus 36% (35-37%) and 23% (21-26%) versus 27% (26-28%) three years post-transplant (P1 year relapse-free is 6.7 (median, 95% CI: 4.5-9.4, 70-79 years) versus 9 (8.4-10.1, 60-69 years) years since landmark. Three years after RFS of one year, excess NRM is 14% (95% CI: 12-18%) in patients aged 70-79 versus 12% [11-13%] in patients aged 60-69, while population NRM is 7% (6-7%) versus 3% (3-3%). Mortality for reasons other than relapse, GvHD, or age is as high as 27% (24-29%) and 22% (22-23%) four years after transplantation. In conclusion, survival amongst older patients is adequate after allogeneic stem cell transplantation.
