Low transplant related mortality in older patients with hematologic malignancies undergoing autologous stem cell transplantation.
OBJECTIVE
Patients over 60 years are frequently excluded from autologous stem cell transplantation (ASCT) programs due to a traditionally high rate of transplant-related mortality (TRM) in such indications. We evaluated the results of ASCT in a group of 49 patients >= 60 years of age [32 males, median age 63 years (range, 60 to 71)] autografted in our institution from January 1995 to December 2001.


METHODS
There were 27 patients with multiple myeloma, 13 with non-Hodgkin's lymphoma, 3 with acute myelogenous leukemia, 3 with chronic myelogenous leukemia and 3 with other hematological malignancies. The Karnofsky score was >= 80% in 47 cases. The median time from diagnosis to ASCT was 12 months (range, 5 to 61). Twenty-four patients were autografted in an early disease phase and 25 (51%) in an advanced phase. Peripheral blood stem cells were used in 46 patients (94%), bone marrow in one (2%) and bone marrow plus peripheral blood in two (4%). Forty-one patients received chemotherapy-only conditioning regimens, while only 8 patients received total body irradiation.


RESULTS
Engraftment occurred in all but one patient. The median times to achieve a sustained absolute neutrophil count > 0.5 x 10(9)/L and a sustained platelet count >20 x 10(9)/L were 13 (range, 10 to 35) and 13 days (range, 8 to 62), respectively. The actuarial 2-year overall survival was 67% [95% confidence interval (CI), 52-82%). Four patients died without progression due to central nervous system (CNS) hemorrhage (n = 1), CNS toxicity (n = 1), fungal infection (n = 1) or toxoplasmosis (n = 1). One hundred-day and 1-year actuarial TRM were 4% (95% CI, 1-16%) and 8% (95% CI, 3-21%), respectively.


CONCLUSIONS
ASCT is a feasible procedure in selected elderly patients, with apparently similar rates of engraftment and TRM to those reported for younger patients.
Villela
Luís
L
Servei d'Hematologia Clínica, Hospital de la Santa Creu i Sant Pau, Antoni Maria i Claret 167, 08025 Barcelona, Spain.
Sureda
Anna
A
Canals
Carme
C
Sanz
Miguel Angel
MA
Martino
Rodrigo
R
Valcárcel
David
D
Altés
Albert
A
Briones
Javier
J
Gómez
Marta
M
Brunet
Salut
S
Sierra
Jorge
J
D000367:Age Factors; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D019337:Hematologic Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D016019:Survival Analysis; D014182:Transplantation, Autologous / Q000401:mortality; D016896:Treatment Outcome