Comorbidities, not age, impact outcomes in autologous stem cell transplant for relapsed non-Hodgkin lymphoma.
High-dose chemotherapy followed by autologous peripheral blood stem cell transplantation is a widely applied treatment for advanced non-Hodgkin lymphoma (NHL), but few studies have analyzed the tolerability and outcomes in older patients compared with younger patients treated in a homogeneous manner. We retrospectively reviewed 152 consecutive patients who underwent autologous stem cell transplantation (ASCT) following BEAM conditioning (carmustine, etoposide, cytarabine, and melphalan) for NHL from January 2000 through August 2004 at our institution. We compared 59 patients age > or =60 years and 93 patients age <60 years. Supportive care was identical for all patients. The frequency of comorbidities was similar between both groups. CD34+ cell doses, days to neutrophil recovery, and days to platelet count >20,000/mm3 were similar in younger and older patients, although days to platelet count >50,000/mm3 were longer in the older patients (median 30.0 days versus 22.5 days, P = .01). Patients over the age of 60 were more likely to develop grade III/IV mucositis than their younger counterparts (37.7% versus17.4%, P = .0063). Otherwise, the frequency of other grade III/IV toxicities were similar between younger and older patients. Treatment-related mortality (TRM) was similar between older and younger patients (8.5% versus 5.4%, P = .45). Although age was not associated with TRM, the Charlson Comorbidity Index Score was significantly correlated with TRM (P = .03). Median disease-free survival was similar between older and younger patients (21.8 months versus 29.9 months, P = .93), as was overall survival (OS) (47.7 months versus 62.5 months, P = .20). After controlling for age, the Charlson Comorbidity Index Score influenced OS [P = .013]. Overall, our cohort of patients with NHL over the age of 60 who underwent ASCT following BEAM conditioning experienced toxicities and survival similar to their younger counterparts. Comorbidities significantly influenced TRM and OS in this retrospective cohort. Future study should focus on improving tolerability of conditioning and careful prospective evaluation of comorbidities and their association with outcomes.
Washington University School of Medicine, St. Louis, Missouri 63110, USA. twildes@im.wustl.edu
Tanya M
TM
Wildes
Kristan M
KM
Augustin
Diane
D
Sempek
Qin Jean
QJ
Zhang
Ravi
R
Vij
John F
JF
Dipersio
Steven M
SM
Devine
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D002330:Carmustine; D003561:Cytarabine; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000150:complications* / Q000628:therapy*; D008297:Male; D008558:Melphalan; D008875:Middle Aged; D011034:Podophyllotoxin; D012189:Retrospective Studies; D012720:Severity of Illness Index; D033581:Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D014182:Transplantation, Autologous
D003561:Cytarabine; D011034:Podophyllotoxin; D008558:Melphalan; D002330:Carmustine