Autologous hematopoietic cell transplantation (HCT) for non-Hodgkin lymphoma (NHL) in patients over 60 years of age

Abstract

20620 Background: High dose chemotherapy followed by autologous HCT is the treatment of choice for relapsed NHL. Safety and efficacy in elderly patients has not been adequately studied. Methods: This is an IRB approved review of records. Patients with NHL, older than 60 years, treated with HCT between August 1998 and August 2007 were included. Correlation was made between pre-existing comorbidity and toxicity or early death. Results: Sixty-two patients with a median age of 65 years were evaluated. Thirty-eight had diffuse large B-cell lymphoma, 7 had follicular, 7 mantle cell, 8 peripheral T-cell, while 2 had other subtypes. At transplant, 15 patients had primary refractory disease, 19 were on first or second CR, 26 were on first or second relapse and the status of 2 pts was unknown. Fifty-three patients had chemosensitive disease, 6 had chemoresistant disease and 2 had unknown status. Median number of prior regimens is 2. Median Cumulative Illness Rate Scale-Geriatric (CIRS-G) score was 3.5 while median adjusted Charlson and Sorror scores were 0.67 and 1.33, respectively. Twenty-three pts received conditioning with cyclophosphamide, busulfan and etoposide, 15 received carmustine, etoposide, cytarabine, and melphalan (BEAM), 12 BEAM plus rituximab and 12 other regimens. Median CD34+ cells infused was 5.31x106 cells/Kg. Median days to neutrophil and platelets engraftment was 11 and 14 days respectively. With a median follow-up of 9.2 months, overall survival is 50.5% at 2 years and 37.8% at 4 years. Event-free survival is 45.3% at 2-years and 31% at 4 years. There were 3 early treatment- related deaths (4.8%), due to VOD, sepsis syndrome and c.difficile colitis. Neutropenic fever and culture-positive infection ocurred in 53 and 19 patients, respectively. Twenty-five patients developed grade 3–4 mucositis or enteritis, 3 had grade 3 renal toxicity, 1 grade 3 pulmonary, 1 grade 3 hepatic and 3 multi-organ toxicity. Median time of hospitalization was 20 days. There was no significant correlation between comorbidity and transplant related mortality, grade3–4 toxicity or days of hospitalization. Conclusions: Autologous HCT is safe for selected NHL patients over 60 years of age with low comorbidities, and the efficacy is comparable to that in younger patients. No significant financial relationships to disclose.