Late Effects of Autologous Hematopoietic Cell Transplantation (AHCT) in Elderly Patients with Lymphoma

Abstract

Background Limited data is available on long-term effects of autologous hematopoietic cell transplantation (AHCT) in older patients (pts). Methods This single-center, retrospective study examines late cardiopulmonary effects, and overall outcomes of AHCT in 41 pts age ≥ 70, with non-Hodgkin lymphoma (NHL), between 2000-2016. Pre- and post-HCT pulmonary function tests (PFT) and echocardiograms (echo) were compared. Overall survival (OS) and progression-free survival (PFS) were analyzed according to age, gender, histology, stage, number of lines of treatment, diffusing capacity of lungs for carbon monoxide (DLCO), left ventricular ejection fraction (LVEF), and comorbidity index (HCT-CI). Results 41 pts [median age 72 (range 70-75)] received AHCT for follicular or diffuse large B-cell lymphoma (n=18 44%), mantle cell lymphoma (n=15 37%) and T-cell or other NHL subtypes (n=8 20%). Eight (20%), 6 (15%) and 27 (66%) pts had a low (0), intermediate (1-2) and high (≥3) HCT-CI, respectively. All pts except 1, had received anthracycline as part of initial therapy. BEAM was the most common conditioning regimen (n=38 93%). Pre-HCT LVEF was normal in all pts except 1 (45%). Median (range) pre- and post-HCT LVEF was 63% (45-74%) and 64% (39-71%), respectively. Of the 23 pts who had post-HCT echo (median time between pre- and post-HCT echo was 423 days), a mild decrease in LVEF was noted in 3. Only 1 pt had a significant decline of 19%. Pre- and post-HCT pulmonary artery pressure was normal in all. The median (range) of pre-transplant DLCO, FEV1 and FVC were 70% (48-125%), 97% (83-141%), and 98% (57-123%), respectively. Of the 10 pts who had post-HCT PFT (median time between pre- and post-HCT PFT was 405 days), DLCO decline of >10% was the most common abnormality and developed in 4. In 5 pts DLCO improvement of >10% was observed. A >15% improvement in FEV1 and FVC was observed in 5 and 4 pts respectively. The median improvements in FVC, FEV1 and DLCO were 4%, 6% and 10%, respectively. With a median follow-up of 58 months (range 5-123) for survivors, PFS and OS at 3 years were 84% (95% CI, 67-92%) and 94% (95% CI, 80-99%), respectively. In a univariate analysis, age, gender, histology, stage, number of lines of treatment, DLCO, LVEF, and HCT-CI did not affect OS or PFS. Relapse occurred in 11 pts (27%), 8 of whom died. Median time to relapse was 38 months (range 27-100). Secondary malignancies developed in 4 pts (10%) and led to death in 3. Conclusion In our cohort of elderly pts who underwent AHCT, late declines in cardiopulmonary function were minimal, and none resulted in mortality. The most common cause of death was lymphoma recurrence. Secondary malignancy was the only cause of non-relapse mortality. While prospective studies with larger number of pts are needed to evaluate long-term effects of AHCT on different organ functions in elderly, strategies to mitigate risk of relapse remain the most important area to improve outcomes.