High-dose chemotherapy with autologous stem cell transplantation for elderly patients with relapsed/refractory diffuse large B cell lymphoma: a nationwide retrospective study.
The number of elderly patients with diffuse large B cell lymphoma (DLBCL) continues to increase but the data regarding autologous stem cell transplantation (ASCT) for elderly patients are limited. We analyzed 484 patients, ages 60 years or over, diagnosed with relapsed/refractory DLBCL who received ASCT from 1993 to 2010 in the Japan Society for Hematopoietic Cell Transplantation database. Median age was 64 years (range, 60 to 78). To evaluate the impact of age at ASCT, patients were classified into 3 groups: those between the ages of 60 to 64, 65 to 69, and 70 years or over. Overall nonrelapse mortality (NRM) at day 100, 1 year, and 2 years was 4.1%, 5.9% and 7.7%, respectively. NRM did not significantly differ among age groups (P = .60). Two-year progression-free survival (PFS) and overall survival (OS) were 48% and 58%, respectively. PFS and OS were significantly longer in patients 60 to 64 years old; however, the survival rate was acceptable even in those 70 or over, with a 2-year OS of 46%. ASCT is feasible in selected elderly patients and age alone should not be a contraindication for ASCT. Eligibility should be individualized and identification of a subset of elderly patients at high risk of treatment-related morbidity or mortality warrants investigation.
Division of Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan. Electronic address: dchihara@aichi-cc.jp.
Dai
D
Chihara
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Koji
K
Izutsu
Department of Hematology and Oncology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Eisei
E
Kondo
Department of Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan.
Rika
R
Sakai
Department of Hematology, Fujita Health University Hospital, Toyoake, Japan.
Shuichi
S
Mizuta
Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Kenji
K
Yokoyama
Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
Hiroto
H
Kaneko
Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Science, Fukuoka, Japan.
Koji
K
Kato
Department of Hematology, Tsukuba University Hospital, Tsukuba, Japan.
Yuichi
Y
Hasegawa
Department of Internal Medicine, Niigata Cancer Center Hospital, Niigata, Japan.
Takaaki
T
Chou
Department of Hematology, Sumitomo Hospital, Osaka, Japan.
Hiroyuki
H
Sugahara
Department of Hematology, Hamanomachi Hospital, Fukuoka, Japan.
Hideho
H
Henzan
Department of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan.
Hisashi
H
Sakamaki
Department of HSCT Data Management/Biostatistics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ritsuro
R
Suzuki
Cancer Center, Shimane University Hospital Cancer Centre, Izumo, Japan.
Junji
J
Suzumiya
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols; D016190:Carboplatin / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009607:Nitrosourea Compounds / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous
D009607:Nitrosourea Compounds; D003561:Cytarabine; D005047:Etoposide; D003520:Cyclophosphamide; D016190:Carboplatin; D008558:Melphalan; C020766:ranimustine
Autologous stem cell transplantation; Diffuse large B cell lymphoma; Elderly patients; Relapse/refractory