title: Allotransplantation for patients age ≥40 years with non-Hodgkin lymphoma: encouraging progression-free survival.
abstract: Non-Hodgkin lymphoma (NHL) disproportionately affects older patients, who do not often undergo allogeneic hematopoietic cell transplantation (HCT). We analyzed Center for International Blood and Marrow Transplant Research data on 1248 patients age ≥40 years receiving reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT for aggressive (n = 668) or indolent (n = 580) NHL. Aggressive lymphoma was more frequent in the oldest cohort 49% for age 40 to 54 versus 57% for age 55 to 64 versus 67% for age ≥65; P = .0008). Fewer patients aged ≥65 had previous autografting (26% versus 24% versus 9%; P = .002). Rates of relapse, acute and chronic GVHD, and nonrelapse mortality (NRM) at 1 year post-HCT were similar in the 3 age cohorts (22% [95% confidence interval (CI), 19% to 26%] for age 40 to 54, 27% [95% CI, 23% to 31%] for age 55 to 64, and 34% [95% CI, 24% to 44%] for age ≥65. Progression-free survival (PFS) and overall survival (OS) at 3 years was slightly lower in the older cohorts (OS: 54% [95% CI, 50% to 58%] for age 40 to 54; 40% [95% CI, 36% to 44%] for age 55 to 64, and 39% [95% CI, 28% to 50%] for age ≥65; P < .0001). Multivariate analysis revealed no significant effect of age on the incidence of acute or chronic GVHD or relapse. Age ≥55 years, Karnofsky Performance Status <80, and HLA mismatch adversely affected NRM, PFS, and OS. Disease status at HCT, but not histological subtype, was associated with worse NRM, relapse, PFS, and OS. Even for patients age ≥55 years, OS still approached 40% at 3 years, suggesting that HCT affects long-term remission and remains underused in qualified older patients with NHL.
authors.affiliation: Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Brian L
authors.initials: BL
authors.lastname: McClune
authors.affiliation: Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Kwang Woo
authors.initials: KW
authors.lastname: Ahn
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Hai-Lin
authors.initials: HL
authors.lastname: Wang
authors.affiliation: Division of Hematologic Oncology, Dana Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.affiliation: Section of Hematology/Oncology, University of Chicago School of Medicine, Chicago, Illinois.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Artz
authors.affiliation: Department of Hematology, University Hospital, Grenoble, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Cahn
authors.affiliation: Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Deol
authors.affiliation: Department of Hematology, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: César O
authors.initials: CO
authors.lastname: Freytes
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA.
authors.forename: Leona A
authors.initials: LA
authors.lastname: Holmberg
authors.affiliation: Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Madan H
authors.initials: MH
authors.lastname: Jagasia
authors.affiliation: Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY.
authors.forename: Ann A
authors.initials: AA
authors.lastname: Jakubowski
authors.affiliation: Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Kharfan-Dabaja
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Department of Oncology, Baylor University Medical Center, Dallas, TX.
authors.forename: Alan M
authors.initials: AM
authors.lastname: Miller
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
authors.forename: Richard
authors.initials: R
authors.lastname: Olsson
authors.affiliation: Center for International Blood and Marrow Transplant Research, Minneapolis, Minnesota.
authors.forename: Tanya L
authors.initials: TL
authors.lastname: Pedersen
authors.affiliation: Department of Blood and Marrow Transplantation, Moffitt Cancer Center, Tampa, FL.
authors.forename: Joseph
authors.initials: J
authors.lastname: Pidala
authors.affiliation: Primary Children's Hospital, Division of Hematology/Hematological Malignancies, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pulsipher
authors.affiliation: Department of Hematology, Rambam Medical Center, Haifa, Israel.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Rowe
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
authors.affiliation: Weill Cornell Medical College, New York, NY.
authors.forename: Koen W
authors.initials: KW
authors.lastname: van Besien
authors.affiliation: Bone Marrow and Stem Cell Transplant Center, Winship Cancer Institute, Emory University Hospital, Atlanta, Georgia.
authors.forename: Edmund K
authors.initials: EK
authors.lastname: Waller
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital Center and Research, Riyadh, Saudi Arabia.
authors.forename: Mahmoud D
authors.initials: MD
authors.lastname: Aljurf
authors.affiliation: Banner M.D. Anderson Cancer Center, Gilbert, Arizona.
authors.forename: Görgun
authors.initials: G
authors.lastname: Akpek
authors.affiliation: Department of Stem Cell Transplantation, University of Hamburg, Hamburg, Germany; MLL Munich Leukemia Laboratory, Munich, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
authors.affiliation: Division of Cell Therapy, Duke University Medical Center, Durham, NC.
authors.forename: Nelson J
authors.initials: NJ
authors.lastname: Chao
authors.affiliation: Division of Hematology/Oncology, Massachusetts General Hospital, Boston, MA.
authors.forename: Yi-Bin
authors.initials: YB
authors.lastname: Chen
authors.affiliation: Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Brenda W
authors.initials: BW
authors.lastname: Cooper
authors.affiliation: National Marrow Donor Program, Minneapolis, MN.
authors.forename: Jason
authors.initials: J
authors.lastname: Dehn
authors.affiliation: Division of Hematology/Oncology, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: Marcos J
authors.initials: MJ
authors.lastname: de Lima
authors.affiliation: Division of Hematology/Oncology, Shands HealthCare, University of Florida, Gainesville, FL.
authors.forename: Jack W
authors.initials: JW
authors.lastname: Hsu
authors.affiliation: Haematology Clinical Trial Office, Royal Adelaide Hospital/SA Pathology, Adelaide, Australia.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Lewis
authors.affiliation: Avon Haematology Unit and BCH BMT Unit, Bristol Children's Hospital, Bristol, United Kingdom.
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Division of Hematology & Oncology, University of Kansas, Westwood, KS.
authors.forename: Joseph
authors.initials: J
authors.lastname: McGuirk
authors.affiliation: Department of Pediatric Hematology, Oncology and Stem Cell Transplantation, New York Medical College, Valhalla, NY.
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Cairo
authors.affiliation: Division of Hematology, Academische Ziekenhuis Maastricht, Maastricht, Netherlands.
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.affiliation: Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital City Campus, Victoria, Australia.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Szer
authors.affiliation: Department of Hematologic Malignancies Bone Marrow Transplant, UMass Memorial Medical Center, Worcester, MA.
authors.forename: Muthalagu
authors.initials: M
authors.lastname: Ramanathan
authors.affiliation: Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Seftel
authors.affiliation: Department of Hematology, Hopital Saint Louis, Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Socie
authors.affiliation: Division of Medical Oncology, Barnes Jewish Hospital, St. Louis Children's Hospital, Washington University, St. Louis, MO.
authors.forename: Ravi
authors.initials: R
authors.lastname: Vij
authors.affiliation: Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota.
authors.forename: Erica D
authors.initials: ED
authors.lastname: Warlick
authors.affiliation: Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota. Electronic address: weisd001@umn.edu.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weisdorf
mesh_terms: D000328:Adult; D000367:Age Factors; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous
keywords: Allogeneic; Elderly; Hematopoietic cell transplantation; Lymphoma; Nonmyeloablative; Reduced intensity