title: Low transplant related mortality in older patients with hematologic malignancies undergoing autologous stem cell transplantation.
abstract: 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.
authors.affiliation: Servei d'Hematologia Clínica, Hospital de la Santa Creu i Sant Pau, Antoni Maria i Claret 167, 08025 Barcelona, Spain.
authors.forename: Luís
authors.initials: L
authors.lastname: Villela
authors.forename: Anna
authors.initials: A
authors.lastname: Sureda
authors.forename: Carme
authors.initials: C
authors.lastname: Canals
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Sanz
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Martino
authors.forename: David
authors.initials: D
authors.lastname: Valcárcel
authors.forename: Albert
authors.initials: A
authors.lastname: Altés
authors.forename: Javier
authors.initials: J
authors.lastname: Briones
authors.forename: Marta
authors.initials: M
authors.lastname: Gómez
authors.forename: Salut
authors.initials: S
authors.lastname: Brunet
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
mesh_terms: 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