Assuntos
Alopecia em Áreas/psicologia , Atitude Frente a Saúde , Adolescente , Adulto , Alopecia em Áreas/complicações , Pré-Escolar , Feminino , Humanos , Masculino , Adulto JovemRESUMO
Metabolic syndrome (MetS) is a constellation of cardiovascular risk factors that increases the risk of cardiovascular disease, diabetes mellitus and all cause mortality. Long-term survivors of hematopoietic cell transplantation (HCT) have a substantial risk of developing MetS and cardiovascular disease, with the estimated prevalence of MetS being 31-49% among HCT recipients. Although MetS has not yet been proven to impact cardiovascular risk after HCT, an understanding of the incidence and risk factors for MetS in HCT recipients can provide the foundation to evaluate screening guidelines and develop interventions that may mitigate cardiovascular-related mortality. A working group was established through the Center for International Blood and Marrow Transplant Research and the European Group for Blood and Marrow Transplantation with the goal of reviewing literature and recommend practices appropriate to HCT recipients. Here we deliver consensus recommendations to help clinicians provide screening and preventive care for MetS and cardiovascular disease among HCT recipients. All HCT survivors should be advised of the risks of MetS and encouraged to undergo recommended screening based on their predisposition and ongoing risk factors.
Assuntos
Doenças Cardiovasculares , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Síndrome Metabólica , Aloenxertos , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Humanos , Síndrome Metabólica/etiologia , Síndrome Metabólica/prevenção & controle , Guias de Prática Clínica como AssuntoRESUMO
Alternative donor transplantation is increasingly used for high-risk lymphoma patients. We analyzed 1593 transplant recipients (2000-2010) and compared transplant outcomes in recipients of 8/8 allele HLA-A, -B, -C and DRB1 matched unrelated donors (MUDs; n=1176), 7/8 allele HLA mismatched unrelated donors (MMUDs; n=275) and umbilical cord blood donors (1 or 2 units UCB; n=142). Adjusted 3-year non-relapse mortality of MMUD (44%) was higher as compared with MUD (35%; P=0.004), but similar to UCB recipients (37%; P=0.19), although UCB had lower rates of neutrophil and platelet recovery compared with unrelated donor groups. With a median follow-up of 55 months, 3-year adjusted cumulative incidence of relapse was lower after MMUD compared with MUD (25% vs 33%, P=0.003) but similar between UCB and MUD (30% vs 33%; P=0.48). In multivariate analysis, UCB recipients had lower risks of acute and chronic GVHD compared with adult donor groups (UCB vs MUD: hazard ratio (HR)=0.68, P=0.05; HR=0.35; P<0.001). Adjusted 3-year OS was comparable (43% MUD, 37% MMUD and 41% UCB). These data highlight the observation that patients with lymphoma have acceptable survival after alternative donor transplantation. MMUD and UCB can extend the curative potential of allotransplant to patients who lack suitable HLA matched sibling or MUD.
Assuntos
Antígenos HLA , Transplante de Células-Tronco Hematopoéticas , Teste de Histocompatibilidade , Linfoma/mortalidade , Linfoma/terapia , Doadores não Relacionados , Doença Aguda , Adolescente , Adulto , Fatores Etários , Idoso , Aloenxertos , Doença Crônica , Intervalo Livre de Doença , Feminino , Seguimentos , Doença Enxerto-Hospedeiro/mortalidade , Doença Enxerto-Hospedeiro/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Taxa de SobrevidaAssuntos
Fluordesoxiglucose F18/administração & dosagem , Linfoma não Hodgkin , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/administração & dosagem , Transplante de Células-Tronco , Adolescente , Adulto , Idoso , Aloenxertos , Intervalo Livre de Doença , Feminino , Humanos , Linfoma não Hodgkin/diagnóstico por imagem , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/terapia , Masculino , Pessoa de Meia-Idade , Radiografia , Taxa de SobrevidaAssuntos
Doença Enxerto-Hospedeiro/patologia , Mucosa Nasal/patologia , Doenças Nasais/patologia , Aloenxertos , Doença Enxerto-Hospedeiro/tratamento farmacológico , Doença Enxerto-Hospedeiro/etiologia , Humanos , Linfoma Folicular/patologia , Linfoma Folicular/terapia , Masculino , Pessoa de Meia-Idade , Doenças Nasais/tratamento farmacológico , Doenças Nasais/etiologia , Transplante de Células-Tronco de Sangue Periférico , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/terapiaRESUMO
Physician practice variation may be a barrier to informing hematopoietic cell transplant (HCT) recipients about fertility preservation (FP) options. We surveyed HCT physicians in the United States to evaluate FP knowledge, practices, perceptions and barriers. Of the 1035 physicians invited, 185 completed a 29-item web-survey. Most respondents demonstrated knowledge of FP issues and discussed and felt comfortable discussing FP. However, only 55% referred patients to an infertility specialist. Most did not provide educational materials to patients and only 35% felt that available materials were relevant for HCT. Notable barriers to discussing FP included perception that patients were too ill to delay transplant (63%), patients were already infertile from prior therapy (92%) and time constraints (41%). Pediatric HCT physicians and physicians with access to an infertility specialist were more likely to discuss FP and to discuss FP even when prognosis was poor. On analyses that considered physician demographics, knowledge and perceptions as predictors of referral for FP, access to an infertility specialist and belief that patients were interested in FP were observed to be significant. We highlight variation in HCT physician perceptions and practices regarding FP. Physicians are generally interested in discussing fertility issues with their patients but lack educational materials.
Assuntos
Preservação da Fertilidade/métodos , Conhecimentos, Atitudes e Prática em Saúde , Transplante de Células-Tronco Hematopoéticas/métodos , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Coleta de Dados , Feminino , Preservação da Fertilidade/estatística & dados numéricos , Pesquisas sobre Atenção à Saúde , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/estatística & dados numéricos , Humanos , Infertilidade/prevenção & controle , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados UnidosRESUMO
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (for example, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri- and post-transplant exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplant experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This report provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Programas de Rastreamento/métodos , Adulto , Feminino , Sangue Fetal/citologia , Doença Enxerto-Hospedeiro/prevenção & controle , Guias como Assunto , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Risco , Fatores de Risco , Sobreviventes , Fatores de Tempo , Transplante Autólogo , Transplante Homólogo , Resultado do TratamentoRESUMO
Advances in hematopoietic cell transplantation (HCT) technology and supportive care techniques have led to improvements in long-term survival after HCT. Emerging indications for transplantation, introduction of newer graft sources (eg, umbilical cord blood) and transplantation of older patients using less intense conditioning regimens have also contributed to an increase in the number of HCT survivors. These survivors are at risk for developing late complications secondary to pre-, peri-, and posttransplant exposures and risk factors. Guidelines for screening and preventive practices for HCT survivors were published in 2006. An international group of transplantation experts was convened in 2011 to review contemporary literature and update the recommendations while considering the changing practice of transplantation and international applicability of these guidelines. This review provides the updated recommendations for screening and preventive practices for pediatric and adult survivors of autologous and allogeneic HCT.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Sobreviventes , Humanos , Programas de Rastreamento/métodosRESUMO
Waldenström macroglobulinemia (WM) is a distinct indolent B-cell lymphoproliferative malignancy characterized by IgM paraproteinemia. Although the disease is sensitive to chemo-immunotherapy, it remains incurable and affected patients have a median survival of 5-10 years. Risk stratification in newly diagnosed patients should start with a prognostic evaluation based on the International Prognostic Scoring System for WM (IPSSWM) to identify those patients in whom particularly poor survival with chemotherapy is expected and in whom alternative treatment strategies, such as hematopoietic cell transplantation (HCT), should be considered. High-dose chemotherapy followed by autologous HCT (auto-HCT) results in disease-free survival of 45-65% at 5 years, but is unlikely to be curative. Chemosensitive disease at the time of auto-HCT is the most important prognostic factor for response rate and overall survival. Allogeneic donor HCT may offer a unique immune-mediated GVL effect with a plateau in relapse rates and potential for extended disease-free survival. The risk of allogeneic HCT complications is justified in HCT-eligible patients whose expected survival is <5 years. Here, we present the advances in non-transplant strategies and the therapeutic role of transplant, and suggest a treatment algorithm for selecting a HCT strategy while adhering to current evidence supporting autologous and allogeneic donor HCT for WM.
Assuntos
Transplante de Células-Tronco Hematopoéticas/métodos , Macroglobulinemia de Waldenstrom/terapia , Idoso , Algoritmos , Linfócitos B/citologia , Ensaios Clínicos como Assunto , Intervalo Livre de Doença , Feminino , Humanos , Sistema Imunitário , Imunoglobulina M/química , Imunoterapia/métodos , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Fatores de Tempo , Resultado do TratamentoRESUMO
Little is known about serum vitamin D levels following hematopoietic cell transplantation (HCT). Patients are instructed to avoid sun exposure because of an increased risk of skin cancers. Altered gastrointestinal absorptive capacity as a result of GVHD, bile acid or pancreatic enzyme insufficiency or bacterial overgrowth may lead to difficulty in absorbing the fat-soluble vitamin D. This study was undertaken to determine the prevalence of serum 25-hydroxyvitamin D (25(OH)D) deficiency, and factors associated with 25(OH)D deficiency, among children and adults who were at least 1 year following HCT. A total of 95 participants (54 males and 41 females) completed a questionnaire on usual diet and lifestyle, and provided a blood sample for 25(OH)D determinations between November 2008 and July 2009. The majority of participants had serum 25(OH)D levels ≥75 nmol/L (n=62, 65%), 23 had insufficient levels (50-75 nmol/L) and 10 participants were deficient (<50 nmol/L). The majority of participants reported regular use of vitamin D supplements (n=58, 61%). Prednisone use was significantly inversely associated with serum 25(OH)D concentrations. Total vitamin D intake was the strongest single predictor of 25(OH)D concentrations. These findings suggest that 400-600 IU vitamin D per day appears to be required to achieve optimal serum 25(OH)D concentrations following HCT.
Assuntos
Transplante de Medula Óssea/efeitos adversos , Deficiência de Vitamina D/etiologia , Vitamina D/análogos & derivados , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Criança , Pré-Escolar , Suplementos Nutricionais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Prednisona/efeitos adversos , Luz Solar , Sobreviventes , Vitamina D/administração & dosagem , Vitamina D/sangue , Deficiência de Vitamina D/sangueRESUMO
Long-term survivors of hematopoietic cell transplantation (HCT) are at risk for loss of bone mineral density (BMD) and subsequent osteoporosis. There is a lack of clear guidelines for the screening, prevention and treatment of bone loss after HCT. We reviewed the prevailing literature and provide guidelines developed by our center for the screening and management of this complication. Bone loss occurs predominantly within the first 6-12 months after autologous and allogeneic HCT. Recovery first occurs in the lumbar spine and is followed by a slower recovery of BMD in the femoral neck. BMD may not return to baseline levels in patients with continuing exposure to corticosteroids and calcineurin inhibitors. All HCT recipients should be advised general interventions to reduce fracture risk including adequate intake of calcium and vitamin D. We recommend screening all adult allogeneic and autologous HCT recipients with dual-energy X-ray absorptiometry 1 year after transplantation. Patients at high risk for bone loss (for example, patients receiving ≥ 5 mg of prednisone equivalent daily for > 3 months) can be screened earlier (for example, 3-6 months after HCT). Where indicated, bisphosphonates or other anti-resorptive agents (for example, calcitonin) can be used for prevention or treatment of osteoporosis in adult HCT recipients. Pediatric HCT recipients should be referred to a pediatric endocrinologist for evaluation and treatment of bone loss. There remain several areas of uncertainty that need further research in adult and pediatric HCT recipients, such as the optimal timing and frequency of screening for loss of bone mineral density, relationship of bone loss with risk of fractures, selection of appropriate patients for pharmacologic therapy, and optimal dosing schedule and duration of therapy with anti-resorptive agents.
Assuntos
Reabsorção Óssea , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Osteoporose , Adulto , Reabsorção Óssea/diagnóstico , Reabsorção Óssea/etiologia , Reabsorção Óssea/prevenção & controle , Reabsorção Óssea/terapia , Criança , Humanos , Osteoporose/diagnóstico , Osteoporose/etiologia , Osteoporose/prevenção & controle , Osteoporose/terapia , Guias de Prática Clínica como AssuntoRESUMO
The Diagnosis and Staging Working Group of the NIH Consensus Development Project on Criteria for Clinical Trials in chronic GVHD (CGVHD) recently proposed criteria for diagnosis and assessment of overall CGVHD severity. We retrospectively reviewed 54 consecutive patients diagnosed with CGVHD between January 2002 and December 2005 after sibling donor transplant to assess the applicability of the new criteria in prognosticating survival and transplant-related mortality (TRM). A total of 8 patients (15%) were reclassified as late onset/persistent or recurrent acute GVHD (late aGVHD), 15 (28%) had overlap syndrome and 31 (57%) had classic CGVHD. Three-year overall survival was worse in patients with late aGVHD (3-year probability 25% (95% CI 4-56%)) followed by overlap syndrome (3-year probability 87% (95% CI 56-96%)) and CGVHD (3-year probability 75% (95% CI 54-87%)); P=0.001. Among patients with overlap syndrome and CGVHD, a trend towards worse survival was seen in patients with severe disease (3-year probability 57.3% (95% CI 21-82%)) as compared to mild+moderate disease (3-year probability 85.1% (95% CI 68-94)); P=0.1. This analysis, undertaken in a contemporary cohort of related donor recipients, indicates that the consensus guidelines are applicable to this population of CGVHD patients.
Assuntos
Doença Enxerto-Hospedeiro/diagnóstico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Adolescente , Adulto , Doença Crônica , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Condicionamento Pré-Transplante , Adulto JovemRESUMO
Non-myeloablative (NMA) allogeneic donor SCT for patients with relapsed lymphoma is associated with lower treatment-related mortality (TRM). However, the impact of conditioning intensity on post transplant infections remains unclear. We evaluated infections in 141 consecutive patients with lymphoma who were allografted using NMA (n=76) or myeloablative (MA; n=65) conditioning regimens. Using infection incidence density per 1000 patient days, we accounted for all infectious episodes during the first post transplant year. Before neutrophil engraftment, the NMA cohort had a 53% lower rate of bacterial infection (relative risk=0.47; P=0.06), whereas after engraftment the density of bacterial infections was similar in the two groups. In the first month, both invasive fungal infections and viral infections were twofold less frequent (P=0.22; P=0.06) in NMA patients. Late viral and fungal infections as well as CMV reactivation were infrequent after either conditioning intensity. The 1-year infection-related mortality was significantly lower after NMA conditioning (NMA 9% (3-16%) vs MA 22% (11-40%); P=0.03). NMA allogeneic transplantation for lymphoma patients results in substantially fewer early infections and lower infection-related deaths, although the similar frequency of later infections suggests that immune reconstitution is delayed with either conditioning intensity.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/métodos , Infecções/etiologia , Linfoma/microbiologia , Linfoma/terapia , Condicionamento Pré-Transplante/efeitos adversos , Condicionamento Pré-Transplante/métodos , Adulto , Feminino , Humanos , Infecções/mortalidade , Masculino , Pessoa de Meia-IdadeRESUMO
We conducted a cross-sectional study to estimate the prevalence of metabolic syndrome, a clustering of risk factors associated with cardiovascular disease, among 86 adults who had allogeneic hematopoietic-cell transplant (HCT) as compared with 258 age- and gender-matched US population controls selected from the 2005-2006 National Health and Nutrition Examination Survey database. The median age at study enrollment was 50 years (range, 21-71), and patients were at a median of 3 years (range, 1-21) from HCT. The prevalence of metabolic syndrome was 49% (95% confidence intervals (CI), 38-60%) among HCT recipients, a 2.2-fold (95% CI, 1.3-3.6, P=0.002) increase compared with controls. The prevalence rates of elevated blood pressure and hypertriglyceridemia were significantly higher among HCT recipients than among controls, but the prevalence rates of abdominal obesity, elevated blood glucose and low high-density lipoprotein cholesterol were not. HCT survivors with metabolic syndrome were more likely to have microalbuminuria (43 vs 10%) and elevated creatinine (31 vs 11%). No patient, donor or transplant characteristics were associated with the diagnosis of metabolic syndrome. We conclude that metabolic syndrome occurs frequently among allogeneic HCT survivors who are seen by transplant physicians. Approaches to screening, prevention and management of metabolic syndrome should be developed for HCT recipients.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Síndrome Metabólica/epidemiologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Masculino , Síndrome Metabólica/etiologia , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Condicionamento Pré-Transplante , Transplante Homólogo , Adulto JovemRESUMO
The risk of hypothyroidism after reduced-intensity hematopoietic cell transplantation (HCT) is not well known. We studied the incidence of hypothyroidism among a cohort of HCT recipients who had survived for > or =1 year and received a TBI-based myeloablative (MA) (N=84) or reduced-intensity (N=97) conditioning (RIC) regimen. MA HCT recipients were younger at the time of transplant (median age 37 vs 54 years, P<0.01), otherwise the two groups were comparable. Median follow-up was 28 (range, 12-75) months for MA and 25 (range, 12-67) months for RIC group. The 3-year cumulative incidence of hypothyroidism was 8 and 5%, respectively (P=0.41). In multivariate analysis, both types of conditioning regimens were associated with similar risks for hypothyroidism (relative risk for MA 1.6 vs RIC). At least in the first few years after HCT, the risks for hypothyroidism are similar among patients receiving TBI-based MA and reduced-intensity regimens.
Assuntos
Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Hipotireoidismo/etiologia , Agonistas Mieloablativos/efeitos adversos , Condicionamento Pré-Transplante/efeitos adversos , Irradiação Corporal Total/efeitos adversos , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Hipotireoidismo/diagnóstico , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Transplante HomólogoRESUMO
Iron overload, primarily related to RBC transfusions, is a relatively common complication in hematopoietic cell transplant (HCT) recipients. Iron overload increases the risk of infections, veno-occlusive disease and hepatic dysfunction post transplant. Elevated pretransplant ferritin levels have been reported to increase the risk of nonrelapse mortality following HCT and might influence the risk of acute and chronic GVHD. Serum ferritin is sensitive but not specific for iron overload and is a poor predictor of body iron burden. Estimation of hepatic iron content with a liver biopsy or magnetic resonance imaging should be considered prior to initiating therapy for post transplant iron overload. A subgroup of transplant survivors with mild iron overload and no end-organ damage may not need therapy. Phlebotomy is the treatment of choice with iron-chelation therapy reserved for patients not eligible for phlebotomy. Natural history, evolution and treatment of iron overload in transplant survivors have not been adequately investigated and more studies are needed to determine its impact on short-term and long-term morbidity and mortality.
Assuntos
Transfusão de Eritrócitos/efeitos adversos , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Sobrecarga de Ferro/etiologia , Ferritinas/sangue , Ferritinas/fisiologia , Humanos , Ferro/metabolismo , Sobrecarga de Ferro/terapia , FlebotomiaRESUMO
Veno-occlusive disease is among the most serious complications following hematopoietic stem cell transplantation. While hepatic veno-occlusive disease occurs more commonly, the pulmonary variant remains quite rare and often goes unrecognized antemortem. Endothelial damage may represent the pathophysiologic foundation of these clinical syndromes. Recent advances in the treatment of hepatic veno-occlusive disease may have application to its pulmonary counterpart.
Assuntos
Endotélio/fisiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Pneumopatia Veno-Oclusiva/fisiopatologia , Fibrinolíticos/uso terapêutico , Humanos , Polidesoxirribonucleotídeos/uso terapêutico , Pneumopatia Veno-Oclusiva/etiologiaRESUMO
Hematopoietic growth factors alone or in combination with myelosuppressive chemotherapy are used to mobilize peripheral blood stem cells for autologous transplantation. To identify characteristics of successful mobilization with granulocyte colony-stimulating factor (G-CSF) alone and to study the impact of immediate chemotherapy mobilization following G-CSF mobilization, we treated 175 chemotherapy sensitive lymphoma patients with G-CSF (G) mobilization and leukapheresis followed by chemotherapy plus G-CSF (CG) mobilization and leukapheresis and then autologous transplantation. Patients with stage I/II disease at diagnosis and < or =5 years from diagnosis were more likely to mobilize successfully with G-CSF alone (G). CG mobilization led to superior stem cell yields compared to the preceding mobilization with G (median 2.37 vs 1.37 ( x 10(6)CD34+ cells/kg); P<0.0001). Patients (n=58, 33%) with successful G-CSF mobilization (> or =2 x 10(6) CD34+ cells/kg) had quicker platelet recovery and improved progression free and overall survival compared to patients who had adequate collection only after chemotherapy mobilization or to those who failed to collect an adequate graft with either type of mobilization. The poor clinical outcome of patients with difficult mobilization using either method identifies them as a high-risk group who might benefit from alternative therapies.
Assuntos
Mobilização de Células-Tronco Hematopoéticas , Transplante de Células-Tronco Hematopoéticas , Linfoma/terapia , Adolescente , Adulto , Idoso , Antígenos CD34/metabolismo , Criança , Intervalo Livre de Doença , Feminino , Sobrevivência de Enxerto , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Humanos , Leucaférese , Linfoma/sangue , Linfoma/mortalidade , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Proteínas Recombinantes , Taxa de Sobrevida , Transplante AutólogoRESUMO
Purine analogs are often used for conditioning preceding allogeneic hematopoietic stem cell transplantation (HCT). We prospectively tested fludarabine (Flu) 40 mg/m(2)/day x 5 days vs cladribine (Clad) 10 mg/m(2)/day x 5 days plus oral busulfan (1 mg/kg q6 h x 2 days) and total body irradiation 200 cGy in 32 recipients of matched sibling and unrelated donor (URD) HCT. Patients were similar in age (median 52 years), diagnosis, extensive pre-HCT therapy (56 vs 63%), and high-risk disease status (81 vs 93%). Neutrophil engraftment was prompt (median 11 vs 12 days), but early graft failure using Clad halted randomization. Platelet recovery was prompt (median Flu 18 vs Clad 24 days). Graft-versus-host disease (GVHD) after Flu vs Clad was similar; (acute grade II/IV 56 vs 69%, P=0.26; chronic 50 vs 31%, P=0.27). Nonrelapse mortality (Flu 25 vs Clad 38%, P=0.47) and progression-free survival at 3 years were similar as well. Multivariate analyses showed slightly, but not significantly lower relative risk (RR) of neutrophil engraftment with Clad (RR 0.6 (95% CI 0.2-1.3) P=0.16) and with URD RR 0.4 (0.2-1.0) P=0.04). Older patients with advanced hematologic malignancies achieve satisfactory outcomes using either of these reduced intensity conditioning regimens.