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Older patients/older donors: choosing wisely

Andrew S Artz1

  • 11Division of Hematology-Oncology, The University of Chicago Medicine, Chicago, IL.

Hematology. American Society of Hematology. Education Program
|December 10, 2013
PubMed

Insights

Hematopoietic cell transplantation (HCT) in older adults can offer long-term survival, but careful patient selection and donor choice are crucial. Older sibling donors are often preferred, but matched unrelated donors also provide acceptable outcomes.

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.

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