Older patients/older donors: choosing wisely

Area of Science:

• Geriatric Medicine
• Hematology
• Transplantation Immunology

Background:

• Allogeneic hematopoietic cell transplantation (HCT) in older adults presents challenges in patient selection and donor choice.
• Existing data on HCT for patients aged 50-69 are observational, highlighting the need for better health status assessment.

Purpose of the Study:

• To review current considerations for HCT in older adult patients.
• To evaluate the use of older sibling donors versus matched unrelated donors (MUDs).
• To discuss novel methods for assessing patient health status for transplantation candidacy.

Main Methods:

• Review of observational data on HCT outcomes in older adult populations.
• Analysis of comparative effectiveness between matched sibling donors and MUDs.
• Exploration of functional measures for health status assessment in elderly patients.

Main Results:

• Patients with excellent performance status and low comorbidity show the best long-term survival post-HCT.
• Older matched sibling donors yield equivalent or superior outcomes compared to MUDs.
• MUDs are a viable alternative, offering acceptable outcomes and disease control.

Conclusions:

• Novel health status measures can aid in selecting appropriate HCT candidates among older adults.
• Prioritizing older sibling donors is recommended, but MUDs and alternative donors can be considered.
• Further research is needed for HCT in patients and donors aged 70 and older.