Outcomes of Autologous Stem Cell Transplantation for Lymphoma in the Elderly: A Single Center Experience
Authors: Mohyuddin Ghulam Rehman , DeJarnette Shaun , Divine Clint , Lin Tara L , Shune Leyla , Abhyankar Sunil , Aljitawi Omar S. , Ganguly Siddhartha , McGuirk Joseph , Singh Anurag K. 
Published: October 2019

INTRODUCTION:

Autologous stem cell transplant (ASCT) is a potentially curative option for lymphoma, yet there remains a bias against offering this therapy to the elderly. Patients above age 65 are nearly always excluded from clinical trials with ASCT, limiting our understanding of the efficacy and toxicities of ASCT in this population. This lack of data and bias against ASCT in the elderly may delay referral for patients who may benefit from a transplant. Here, we report our single institution outcomes from all patients aged 65 and greater who underwent autologous stem cell transplant for lymphoma at our institution.

DESIGN AND METHODS :

We identified 93 consecutive patients ³ 65 years of age (median age 68.6 years) with lymphoma who underwent autologous stem cell transplantation at University of Kansas Medical Center from 2000 to 2015. After IRB approval, data was extracted using the institutional database. These patients had frequently received at least two treatments, were often beyond first complete remission at the time of transplantation and received their transplants later after diagnosis. Table 1 below summarizes the pre-transplant characteristics of our patients.

RESULTS:

All patients received G-CSF mobilized peripheral blood stem cells. Engraftment data is available for 87 out of 93 patients. Median number of days to neutrophil recovery (Absolute neutrophil count >500) was 11 (range 9-14). Median number of RBC and platelet transfusion in this group was 2 (range 0-10) and 3 (range 0-39), respectively. Non-relapse mortality at 100 days for the entire group was 2.15%. Overall survival at 100-days was 96.8%. Three patients (3.2 %) developed grade IV pulmonary toxicity and one patient developed grade IV veno-occlusive disease. With a median follow up of 744 days (41-2431), a disease free survival of 373 days was noted. In 63 patients who underwent transplant prior to 2013, 1-year and 2-year overall survival was found to be 84.2% and 72.1 respectively. Of the deaths in first year, 6 (55%) were related to relapse/progression, two (18%) due to pulmonary toxicity, 2 (18%) due to cardiac toxicity and 1 (9%) due to infection. In 17 patients (18.2%), transplant was performed completely/partially as an outpatient procedure.

CONCLUSIONS:

Although retrospective in nature, these results suggest that transplant related mortality in elderly patients with lymphoma is similar to historic younger cohorts. Chronological age should not be used alone in evaluating lymphoma patients for autologous stem cell transplantation. Instead, a comprehensive evaluation using Hematopoietic cell transplant comorbidity index and geriatric assessment should be used to guide decision-making. As the elderly population grows, an individualized approach to each patient considering all available treatment options is needed to make a potentially curative ASCT for high risk or relapsed lymphoma available to more patients.

Table 1. No of patients (%) GenderMale Female 60 (65) 33 (35) Age at ASCT, median (range) 68.6 ( range 65-80) Hodgkin Disease Non Hodgkin Disease 5 (5) 88 (95) NHL subtypes Diffuse Large B- Cell Lymphoma Mantle Follicular Other 35 (40) 18 (20) 16 (18) 19 (22) Disease Status at ASCTCR1 CR 2 or more CRU PR Relapse1 Relapse 2 or more Primary Refractory 29 (31.2) 29 (31.2) 6 (6.5) 19 (20.4) 5 (5.4) 2 (2.2) 3 (3.2) Response to most recent chemoComplete remission Partial remission Progressive disease 64 (68.9) 19 (20.4) 10 (10.8) HCT-CI (% from those with obtained data) 0 1-2 3 or more N/A 15(19.0) 23(29.1) 41(51.9) 14

Disclosures

No relevant conflicts of interest to declare.