The Outcome of Hematopoietic Cell Transplantation (HCT) for Myelodysplastic Syndrome (MDS) in Adults ≥65 Years of Age: First Report of the Coverage with Evidence Development (CED) in Medicare Beneficiaries

Abstract 1983

Despite recent advances in treatment for MDS, allogeneic HCT remains the only curative therapy. Historically, patients (pts) ≥65 years with Medicare did not have coverage for HCT. On August 4^th 2010, the Centers for Medicare and Medicaid services (CMS) approved coverage for HCT for MDS through coverage with evidence development (CED). A Center for International Bone Marrow Transplant Research (CIBMTR) study comparing outcomes of pts 55–64 vs. 65 and older was approved. Since the study initiation the number of HCT performed in pts≥65 years old has nearly doubled from a pre-study average of 75/year to 154 in 2011. As of May 2012, 220 pts have been enrolled; 120 have ≥100 days of follow-up. The median age at HCT was 67 (range 65–74); only 24% were >70 years old and 20% (n=23) had therapy related MDS. At the time of HCT, 45% had refractory anemia with excess blasts −1/2 and 32% had refractory anemia ± ringed sideroblasts/refractory cytopenia with multilineage dysplasia. The modified International Prognostic Scoring System (IPSS) score was low, intermediate-1 (INT-1), INT-2 and high risk in 17%, 36%, 32% and 5% of pts, respectively. Donors were an HLA identical sibling, unrelated adult donor (URD) or cord blood (UCB) in 25%, 73% and 2% respectively. Of the 88 patients who received an URD HCT, 70 (80%) were HLA 8/8 allele matched. Twenty five pts (21%) (95% CI, 14–29%) died before 100 days. Causes of death were graft rejection/failure (1), infection (5), interstitial pneumonitis (1), GVHD (3), relapse (6), organ failure (8) and unknown (1). The probability of death at 100 days after HCT in all patients' ages 55–64 transplanted for MDS in 2010–2011 reported to the CIBMTR is 17%. (95% CI, 15–20%).