Based on frailty research suggesting that weight loss and gain may contribute to outcomes in older patients, Dr. Imus and his colleagues also performed a landmark analysis looking at weight change at 6 months versus pretreatment weight, and found that OS was 31 months in those with greater than the median loss of 4.4 kg, compared with 79 months in those who maintained or regained weight and who therefore had less than the median weight loss at 6 months.
The patients in this series had a median age of 72 years, and the refined disease risk index was low in 9% of patients, intermediate in 77%, and high or very high in 13%. All received nonmyeloablative (NMA) conditioning, PTCy and mycophenolate mofetil prophylaxis from day 5 to day 35, and either tacrolimus and sirolimus from day 5 to day 60-180.
The graft source was bone marrow in 75% of patients.
Engraftment in this population was acceptable and similar to that seen in younger patients; there were seven graft failures, with most occurring in patients who received bone marrow grafts, Dr. Imus said.
The incidence of severe, acute, and chronic graft-versus-host disease was about 10% for each, and was also similar to what is seen in younger patients, he noted.
The findings are of interest because many hematologic malignancies in septuagenarians are associated with very poor survival in the absence of alloBMT. It has only been in recent years that advances in NMA conditioning and haploidentical donor use have made alloBMT more available to older patients, he explained.
With increasing numbers of patients over age 70 years being offered the therapy – about 10% of adult alloBMT recipients at Johns Hopkins are over age 70 now – it was of interest to look at these outcomes, he said, adding that the findings demonstrate that hematologic malignancies in older patients are curable with alloBMT.
“Patients should not be denied therapy based on age alone,” Dr. Imus said, noting that in an effort to address the finding of increased graft failures in those receiving bone marrow grafts at Johns Hopkins, peripheral blood is now being used in certain cases.
“Nonrelapse mortality continues to be a major challenge in this group. It rivals relapse for poor outcomes, especially for late nonrelapse mortality,” he said, concluding that prospective studies looking at NRM are warranted.
Dr. Imus reported having no financial disclosures.
SOURCE: Imus P et al. TCT 2019, Abstract 42.