The Influence of Age on Outcomes in Patients Who Receive Autologous Stem Cell Transplantation.
Authors: Goodyear Dawn M. , Gulliver Yvonne , Duggan Peter R. 
Published: October 2019

Introduction: Most randomized trials that evaluate the use of autologous stem cell transplantation (ASCT) exclude older patients due to the expectation of more complications and higher mortality. There is little prospective randomized data assessing the benefit of ASCT in older patient groups. Despite this, ASCT is frequently being offered to older patients with myeloma and NHL. The aim of this project is to compare outcomes of patients younger and older than 60 years of age who have received an ASCT.

Methods: Review of a prospective database of all patients who have undergone ASCT at the St. John’s Health Sciences Centre since 2001. Outcome data collected included hematopoietic recovery and transfusion requirements, occurrence of NCI grade 3 or 4 toxicity (hematologic toxicity excluded), and transplant-related mortality. Mild (grade1–2) toxicity was not compared. The rate of febrile neutropenia was studied separately from other NCI toxicities.

Results: Between November 2001 and June 2006 stem cell mobilisation was attempted in 125 patients and was successful in 113 (90%). Mobilisation failed in 5/45 (11%) of older patients and 7/80 patients under 60 (9%) (p=0.70). Transplant has not been performed in 17 patients (8 patients have cells stored for future use, 9 patients progressed or developed severe new health issues). 96 patients underwent ASCT. Four patients had a second ASCT during this period, but only data from the first transplant was included in this study. There were 33 patients age ≥ 60 and 63 patients < 60 years. Baseline characteristics are presented in Table 1. Though there was no difference in the median stem cell dose received, when patients were grouped according to the dose received (<2.5, 2.5–5.0, 5.0–10, and > 10 × 106/kg) we see that older patient were more likely to receive a lower stem cell dose (p = 0.033). Despite this, hematopoietic recovery was similar between the two groups. There was no significant difference between time to neutrophil recovery, platelet recovery, transfusion requirements, GCSF administration, and duration of hospitalization (table 2). Febrile neutropenia occurred in 75% of patients < 60 versus 81% of those ≥ 60 (p=ns). Grade 3 or 4 toxicity was experienced by 68% and 67% respectively. There was one death due to transplant related complications in the younger age group, and none in the older group.

Conclusion: This study showed no difference in recovery, toxicity, or transplant-related mortality between younger and older patients after ASCT.

Table 1: Baseline Characteristics < 60 years ≥ 60 years Number of patients 63 33 Male 41 18 Female 22 15 Median Age (Range) 49.6 (21–59) 64.6 (60–73) Diagnosis Non-Hodgkins Lymphoma 28 15 Multiple Myelom 24 17 Hodgkins Disease 9 1 Other 2 0 Conditioning Regimen BEAM 30 13 Melphalan 27 18 Other 6 2 Stem Cell Dose Median CD34 dose* (average, range) 5.7 (7.8, 2.7–50.9) 5.3 (5.7, 2.1–18.4) # receiving < 2.5* 0 4 2.5 – 5.0* 20 12 5.0 – 10.0* 36 14 > 10.0* 7 3 Table 2: Hematologic Recovery < 60 ≥ 60 P-Value Median days to ANC > 0.5 ×109 (range) 10 (8–12) 10 (9–12) .21 Median days to Platelets > 20 (range) 11 (7–54) 11 (8–67) .13 Median RBC Transfusions (ave, range) 0 (1.5, 0–12) 1 (1.9, 0–7) .49 Median platelet transfusions (ave, range) 1 (1.9, 0–26) 2 (1.7, 0–7) .77 Median Days of G-CSF 6 7 .25 Ave # Days in hospital from day 0 – 60 13.2 (0–60) 13.8 (0–35) .79