GeriQBank · Paper III · Q16
Bone Marrow Transplant
- Chapter
- Haematology
- Years asked
- Not recorded in the source
- Frequency
- Set 1× in Paper IV (2009–2025)
As set in the university paper
Bone marrow transplant.
Paper IV · Oncology, Haematology & Cancer Screening · asked ×1 · 7-mark note · see in paper list
Detailed answer
Pro · free in betaAttempt it firstOutline your answer as a 7-mark note before revealing it — definition, causes, evaluation, management and the geriatric angle.Reveal answer
No standalone chapter, but Ch. 27 discusses allogeneic HSCT in real depth, framed around age eligibility — directly quotable.
High-Yield Points
Definition: conditioning regimen + infusion of HLA-compatible stem cells. Allogeneic (curative, immune graft-vs-leukaemia effect) vs autologous ("autografting" — harder in elderly due to mobilisation difficulty).
Donor–versus–leukaemia effect vs GVHD — same donor immune cells that kill leukaemia can attack gut/skin/liver.
Donor sources: related, unrelated, cord blood, haploidentical.
Myeloablative conditioning: mortality 20–50%; age was historically a contraindication because of this.
Reduced-intensity/non-myeloablative (RIC) maximises graft-vs-leukaemia while minimising toxicity — low short-term mortality up to age 70–75, OS comparable to ablative (offset by higher relapse).
US registry: 1106 patients ≥70; proportion rose 0.1%(2000)→3.85%(2013); 2-yr OS improved 26%→39%; 2-yr TRM unchanged at 33–35%.
HCT-CI (Sorror) and Karnofsky performance status are independent predictors of survival.
CGA is "crucial in selecting candidates for transplantation" — Pathy's explicit refrain.
MDS: only potential cure. AML: consolidation after CR for intermediate/unfavourable risk.
Autologous mobilisation becomes progressively more difficult with age.
Latest Updates (2023–Present)
Post-transplant cyclophosphamide (PTCy) has transformed GVHD prophylaxis — BMT CTN 1703 update specifically in patients ≥70 (Blood Adv 2025): GVHD-free/relapse-free survival 67.1% vs 29.5% with Tac/MTX, lower NRM. Authors conclude allo-HCT is underutilised in ≥70 and PTCy should prompt greater consideration. Haploidentical transplant with PTCy now feasible over 70 (Johns Hopkins: 2-yr OS 53%, 180-day NRM 14%). PTCy dose reduced to 80 mg/kg specifically improves elderly outcomes (vs 100 mg/kg). Donor AGE, not donor type, is now the dominant variable — younger haploidentical donor may be preferable to an older matched donor. Letermovir CMV prophylaxis extended to 200 days (ASTCT 2025) — particularly relevant given older recipients' higher CMV seroprevalence.
Current Practice Update
Domain Pathy's (2022) Current evidence
Age ceiling RIC "rarely completed after 70" PTCy-based transplant established into late 70s GVHD prophylaxis Not specified PTCy now preferred platform, proven benefit in ≥70 Donor selection Four types listed, no hierarchy Donor age now more important than donor type CMV prophylaxis Not addressed Letermovir extended to 200 days MD Geriatrics – Haematology Compendium Page 31 of 34
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References
- PAPERS-2-3-4_COMBINED.pdf — page 870
- GeriQBank source PDF — p. 870
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