Older age is perceived by many to be among the most important adverse factors in transplantation. For allo-geneic transplantation in general, the adverse influence of older age largely results from the favorable outcome of pediatric compared to adult patients.32 33 Differences between younger and older adults are less dramatic.

Studies using TBI in the preparative regimen for transplantation in CML have demonstrated a significant adverse influence of advancing age.3435 The Seattle program described a significant adverse affect of age in CML using TBI, but not in patients who receive busulfan133637 (Figure 37.2). Others have similarly failed to identify age as a significant independent prognostic factor in patients who receive busulfan.3839 Results from Ohio State have demonstrated that the influence of age is attributable to other factors, including interval from diagnosis to transplantation, which is generally longer in older patients.39

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