Effect of Age on Outcome of Reduced-Intensity Hematopoietic Cell Transplantation for Older Patients With Acute Myeloid Leukemia in First Complete Remission or With Myelodysplastic Syndrome

Purpose Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) primarily afflict older individuals. Hematopoietic cell transplantation (HCT) is generally not offered because of concerns of excess morbidity and mortality. Reduced-intensity conditioning (RIC) regimens allow increased use of allogeneic HCT for older patients. To define prognostic factors impacting long-term outcomes of RIC regimens in patients older than age 40 years with AML in first complete remission or MDS and to determine the impact of age, we analyzed data from the Center for International Blood and Marrow Transplant Research (CIBMTR). Patients and Methods We reviewed data reported to the CIBMTR (1995 to 2005) on 1,080 patients undergoing RIC HCT. Outcomes analyzed included neutrophil recovery, incidence of acute or chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), relapse, disease-free survival (DFS), and overall survival (OS). Results Univariate analyses demonstrated no age group differences in NRM, grade 2 to 4 acute GVHD, chronic GVHD, or relapse. Patients age 40 to 54, 55 to 59, 60 to 64, and >= 65 years had 2-year survival rates as follows: 44% (95% Cl, 37% to 52%), 50% (95% Cl, 41% to 59%), 34% (95% Cl, 25% to 43%), and 36% (95% Cl, 24% to 49%), respectively, for patients with AML (P = .06); and 42% (95% Cl, 35% to 49%), 35% (95% Cl, 27% to 43%), 45% (95% Cl, 36% to 54%), and 38% (95% Cl, 25% to 51%), respectively, for patients with MDS (P = .37). Multivariate analysis revealed no significant impact of age on NRM, relapse, DFS, or OS (all P>.3). Greater HLA disparity adversely affected 2-year NRM, DFS, and OS. Unfavorable cytogenetics adversely impacted relapse, DFS, and OS. Better pre-HCT performance status predicted improved 2-year OS. Conclusion With these similar outcomes observed in older patients, we conclude that older age alone should not be considered a contraindication to HCT.

Well-preserved Late Paleoproterozoic volcanic centers in the Sao Felix do Xingu region, Amazonian Craton, Brazil

The Amazonian craton in the Sao Felix do Xingu city, southeast region of the Para state, north of Brazil, hosts exceptionally well-preserved Paleoproterozoic bimodal magmatic units grouped in the Sobreiro and Santa Rosa formations. These formations are correlated to the Uatuma magmatic event, which is largely distributed in the Amazonian craton occupying more than 1,500,000 km(2). Geological mapping and petrographical observations reveal distinct spectra of volcanic facies in both formations. The basal calc-alkaline Sobreiro Formation is composed mainly of andesitic and dacitic lava flows and associated volcaniclastic facies of autoclastic origin, with subordinate pyroclastic flow deposits. This formation shows inferred eruption style that is similar to those in Flood Basalt Provinces, with rare scutulum-type lava shields. The upper A-type Santa Rosa Formation was generated by multicyclic explosive and effusive episodes predominantly associated with large fissures and is materialized by voluminous ignimbrites with subordinated ash-fall tuff, crystal tuff, lapilli-tuff, co-ignimbritic breccias, rhyolitic dikes and domes, and associated granitic porphyries and equigranular granitic intrusions. Ignimbrite and rhyolite dikes reveal conspicuous vertical flow pattern pointing to a fissure-controlled eruption, similar to Sierra Madre Occidental ignimbrite province. The proposed evolutionary model for the Sao Felix do Xingu units differs from those of other occurrences related to the Uatuma magmatic event in the Amazonian craton, characterized by predominance of A-type volcanism and contemporaneous granites. (C) 2010 Elsevier B.V. All rights reserved.