Old age: the crown of life, our play's last act. Question and answers on older patients undergoing allogeneic hematopoietic cell transplantation

被引:1
作者
Maffini, Enrico [1 ]
Festuccia, Moreno [2 ]
Ursi, Margherita [3 ]
Barbato, Francesco [3 ]
Dicataldo, Michele [3 ]
Roberto, Marcello [3 ]
Campanini, Elena [1 ]
Dan, Elisa [1 ]
De Felice, Francesco [3 ]
De Matteis, Serena [1 ]
Storci, Gianluca [1 ]
Bonafe, Massimiliano [3 ]
Arpinati, Mario [1 ]
Bonifazi, Francesca [1 ]
机构
[1] IRCCS Azienda Osped Univ Bologna, I-40126 Bologna, Italy
[2] Azienda USL Valle Aosta, Internal Med Div, Aosta, Italy
[3] Univ Bologna, Dept Expt Diagnost & Specialty Med, Bologna, Italy
关键词
acute myeloid leukemia; allogeneic hematopoietic cell transplantation; conditioning; Human leukocyte antigen (HLA)-matched unrelated donors; old patients; ACUTE MYELOID-LEUKEMIA; COMPREHENSIVE GERIATRIC ASSESSMENT; 1ST COMPLETE REMISSION; COMORBIDITY INDEX; ELDERLY-PATIENTS; UNRELATED DONOR; CORD BLOOD; POSTTRANSPLANTATION CYCLOPHOSPHAMIDE; HEMATOLOGIC MALIGNANCIES; INTENSIVE CHEMOTHERAPY;
D O I
10.1097/MOH.0000000000000743
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Purpose of reviewSeveral studies showed that age alone should not be used as an arbitrary parameter to exclude patients from allogeneic hematopoietic cell transplantation (HCT). The accessibility to allogeneic HCT programs for older patients with hematological diseases is growing up constantly. The Center for International Blood and Marrow Transplant Research has recently shown that over 30% of allogeneic HCT recipients are at least 60 years old and that nearly 4% are aged 70 or more. Historically, the use of allogeneic HCT among elderly patients has been limited by age restrictions, reflecting physicians' concerns regarding prohibitive transplant-related mortality and HCT-associated morbidity.Recent findingsThe introduction of reduced intensity/toxicity conditioning regimens has allowed transplant Centers to carry out allogeneic HCT on patients previously considered not ideal candidates. The integration of specific risk scores could lead to better capture mental and physical frailties of older patients. Older adults less frequently have available medically fit siblings, able to donate, so, unrelated donors, familial haploidentical donors or umbilical cord blood grafts could potentially abrogate such a difficulty, allowing the curative potential of allogeneic HCT.SummaryThe appropriate assessing of allogeneic HCT feasibility for elderly patients should be the resonate application of different clinical and biological principles.
引用
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页码:14 / 21
页数:8
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