Transplant-related mortality in patients older than 60 years undergoing autologous hematopoietic stem cell transplantation.
Although high-dose therapy with autologous hematopoietic stem cell transplantation (ASCT) is a widely used method of dose intensification in patients with hematological malignancies, patients aged over 60 are generally excluded. We evaluated high-dose therapy and ASCT in 29 cases involving 27 such patients (median age 63 years; range 61-68) with different malignancies. Patients were eligible if they had a good performance status, normal cardiac, respiratory, and hepatic function and a serum creatinine concentration of less than 2 mg/dl (<5 mg/dl in myeloma patients). Engraftment was assessable in 27 procedures. The median time to attain 0.5 and 1 x 10(9) PMN/l was 13 days (range 9-30) and 14 days (range 10-66), respectively. The median time taken to reach a platelet count greater than 50 x 10(9)/l was 14 days (range 8-223). Five patients (17%) died in the first 100 days after transplant, in two cases due to disease progression. The remaining three patients died as a consequence of transplant-related complications, with an overall transplant-related mortality of 10%. Five patients relapsed and died between 5 and 36 months after transplant. The remaining 17 patients are still alive without disease progression, with an actuarial overall survival of 47% at 42 months (95% CI 33-61). We consider that high-dose therapy with ASCT should be considered in those elderly patients with good performance status and without general organ impairment.
de la Rubia
J
J
Bone Marrow Transplant Unit, Hematology Service, University Hospital La Fe, Valencia, Spain.
Saavedra
S
S
Sanz
G F
GF
Martín
G
G
Moscardó
F
F
Martínez
J
J
Jarque
I
I
Jiménez
C
C
Sanz
M A
MA
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001804:Blood Transfusion, Autologous / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D014182:Transplantation, Autologous / Q000401:mortality