Favorable Outcomes in Elderly Patients Undergoing High-Dose Therapy and Autologous Stem Cell Transplantation for Non-Hodgkin Lymphoma

Abstract

High-dose therapy and autologous stem cell transplantation (HDT-ASCT) can offer potential long-term remission or cure in patients with non-Hodgkin lymphoma (NHL). Limited experience is available on the safety and efficacy of HDT-ASCT in elderly patients. This is a single-center, retrospective study examining outcomes of HDT-ASCT for 202 NHL patients age 60 years and older between January 2001 and December 2012. Overall survival (OS) and progression-free survival (PFS) were analyzed according to age at HDT-ASCT, hematopoietic cell transplantation comorbidity index (HCT-CI), NHL histology, and remission status at the time of HDT-ASCT. The median age was 65 years (range 60–74) and the majority had either diffuse large B-cell lymphoma (DLBCL, n=73, 37%) or mantle cell lymphoma (MCL, n=69, 34%). One hundred and fifteen patients (57%) had high HCT-CI scores at the time of HDT-ASCT. With a median follow-up of 3.6 years (range 0.4–11.9 years) for survivors, PFS and OS at 3 years were 60% (95% CI: 53–68%) and 73% (95% CI: 67–80%), respectively. Transplant-related mortality (TRM) was 4% both at 100 days and at 1 year post HDT-ASCT. Age and HCT-CI score were not associated with OS or PFS, and high HCT-CI did not correlate with TRM. Seven patients (4%) developed secondary myelodysplastic syndrome (MDS) or acute myeloid leukemia (AML) at a median of 35 months (range 6–48) post HDT-ASCT. In this single-center cohort of elderly patients with NHL undergoing HDT-ASCT, this intervention is proved tolerable and effective, with results similar to historic controls in younger patients. Our data suggest that age alone should not preclude HDT-ASCT in elderly patients.