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According to an investigation in the November 2 issue of JAMA , older individuals who received a conditioning regimen thatconsisted of minimal-intensity radiation therapy for advancedhematologic malignancies, such as lymphoma and leukemia , before receiving allogeneic (genetically different) hematopoieticcell transplantation (HCT; recipe of stem cells or bone marrow transplant) had progression-free and survivaloutcomes indicating that this treatment method might be a suitableoption for older individuals with these cancers . Background information in the study suggests: "Increasing age has been historically implicated in highermortality after high-dose allogeneic HCT for patients withhematologic malignancies [cancers of the blood or bone marrow].Such transplants are preceded by intense, cytotoxic [toxic tocells] conditioning regimens aimed at reducing tumor burden. The risk of organ toxicities has limited the use of high-doseregimens to younger patients in good medical condition. Therefore,age cutoffs of 55 to 60 years have been in place for decades forhigh-dose HCT. This excluded the vast majority of patients fromallogeneic HCT, given that median [midpoint] ages of patients atdiagnoses of most hematologic malignancies range from 65 to 70years." In order to address this limitation, scientists developed anonmyeloablative conditioning regimen for allogeneic HCT, which isa procedure that uses lower doses of chemotherapy and/or radiationwithout causing eradication of all bone marrow cells before stemcell transplant. The procedure relies on graft-vs.-tumor effects totreat cancer and involves fludarabine, a chemotherapy drug,together with a low dose of total-body irradiation prior to HCT anda course of immunosuppression. The researchers explain: "This regimen has allowed extension of allogeneic HCT to apreviously unserved population of older or medically infirmpatients." Mohamed L. Sorror, M.D., M.Sc., of the Fred Hutchinson CancerResearch Center, Seattle, and his team conducted a study in orderto evaluate the outcomes of older individuals who suffer fromadvanced hematologic malignancies who received minimally toxicnonmyeloablative allogeneic HCT. From 1998 to 2008 the study enrolled 372 patients aged between 60to 75 years (median age, 64 years), in prospective clinical HCTtrials at 18 participating institutions using conditioning withlow-dose total body irradiation alone or together with fludarabine,before related (n = 184) or unrelated (n = 188) donor transplants.In addition participants received post-grafting immunosuppressivetherapy. The main outcomes measured for the investigation wereoverall and progression-free survival. 133 of the 372 patients were alive as of June 23, 2010, with amedian follow-up of 55 months. The team discovered that overall,progression of the disease or relapse has been the most prevalentcause of death (n=135). Deaths that were no related to relapseoccurred among 104 patients, primarily due to infections,multi-organ failure and graft-vs.-host disease (GVHD). Overall 5year progression-free and survival rates were 35% and 32%respectively. In addition the overall five year cumulativeprevalence of relapse was 41%. The prevalence of non-relapse mortality at five years was similaramong the three age groups - 27% for individuals aged between 60 to64, 26% for patients aged 65 to 69, and 31% for those aged 70+. Forindividuals 60-64 the five-year overall survival rate was 38%, forpatients 65-69 33%, and for those aged 70+ 25%. Furthermore, worse outcomes were connected with comorbid conditionsand risks for relapse, but not increasing age. Over half ofparticipants were never hospitalized, and two-thirds of those whosurvived eventually experienced resolution of their chronic GVHDwith physical function returning to normal or near-normal. The researchers explain: "While there is much room for improvement, particularly with regardto relapse, these results are encouraging given the poor outcomeswith nontransplantation treatments, especially for patients withhigh-risk acute myeloid leukemia , fludarabine-refractory chronic lymphocytic leukemia, orprogressive lymphoma. The older population is increasing;demographic changes in the United States suggest that 20 percent ofthe population will be 65 years or older by 2030. Furthermore, increases of up to 77 percent in the number of newlydiagnosed hematologic malignancies among the older population areexpected to occur in the next 20 years. Greater age is alsoassociated with increased medical comorbid conditions. Thus,establishing treatment options with curative outcomes andnear-normal long-term physical function have become an importantfuture goal for older patients with hematologic malignancies." In an Associated Report in the same journal, Shin Mineishi, M.D.,of the University of Michigan, Ann Arbor, Mich., comments on thediscoveries of this investigation: "Development and refinement of reduced-intensity, nonmyeloablativeallogeneic hematopoietic stem cell transplantation (HSCT) has beenan important accomplishment in HSCT over the last 15 years. Asreported by Sorror et al, even among patients aged 60 through 75years overall survival, progression-free survival, and otheroutcomes now appear almost comparable to those in younger patients.Although age alone should no longer be considered a limiting factorfor allogeneic HSCT, more questions have been raised, and moreproblems need to be resolved for achieving optimal outcomes forolder patients receiving allogeneic HSCT." Written by: Grace Rattue Copyright: Medical News Today Not to be reproduced without permission of Medical News Today Additional References Citations. 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