The Role of Age in Bone Marrow and Stem Cell Transplants for MDS

Ronald L. Paquette, MD, clinical director of the Stem Cell and Bone Marrow Transplant Program at Cedars-Sinai Medical Center and Samuel Oschin Cancer Center, discusses how age impacts the use of bone marrow and stem cell transplants in patients with myelodysplastic syndrome (MDS).

According to Paquette, the median age of patients diagnosed with MDS is 70 to 71 years old, while patients are often not considered eligible for bone marrow and stem cell transplants beyond the age of 75. This means many patients are close to being ineligible for transplant.

He says that patients over 70 who receive transplants for MDS and other hematologic malignancies generally do not have worse survival than younger patients. While this could be due to these patients being selected for transplant eligibility based on better health and fitness, age is not the most significant factor for a successful transplant.

However, older patients tend to be given reduced-intensity myeloablative conditioning before transplant more often compared with younger patients. Paquette says non-myeloablative conditioning is sometimes used for less fit patients, but less intense myeloablative conditioning is preferred for patients with a moderate to high risk of relapse to improve their outcomes and reduce risk of relapse.

TRANSCRIPTION:

0:08 | The median age of the diagnosis of MDS is something around 70 or 71 years of age. As a result, the majority of patients who are diagnosed will be of an age group which is just at the borderline of consideration for transplant. The cutoff at our center is arbitrarily set at 75, but I'm looking at the outcomes of patients over the age of 70, who have been transplanted for a variety of different hematologic malignancies. It is apparent that their survival is not dissimilar from that of patients who are younger than 70. That obviously reflects a very careful selection of people who are older who are most fit, but by the same token, age as a discriminating factor seems to be less important than all the other things.

1:04 | That said, we can't give the same intensity of therapy to older patients that we give to younger patients. We primarily use reduced-intensity conditioning for the patients who are older and the older [patients with] MDS in particular. The use of non-myeloablative conditioning is on occasion used for those who are perhaps less fit, but we tend to gravitate towards a reduced-intensity conditioning regimen for those patients who have a moderate to high risk of relapse because that's primarily what the intensity is attempting to address, is reducing the risk of relapse for patients who have higher-risk disease.