Feasibility and Outcome of High Dose Therapy Followed by Autologous Stem Cell Transplantation in Relapsed/Refractory Lymphoma in the Geriatric Population
Authors: Mato Anthony R , Goy Andre , Waksmundzki Kathryn , Feldman Tatyana , Zielonka Tania , Protomastro Ewelina A , Bejot Coleen , Gadaleta Gabriella , Rowley Scott D , Donato Michele L , Pecora Andrew L , Facchin Katherine , Leonard John P. , Furman Richard R. , Ruan Jia , Shore Tsiporah B , Gergis Usama , Coleman Morton , Elstrom Rebecca 
Published: October 2019

Abstract
Abstract 4269

Introduction:
High-dose chemotherapy with autologous stem cell rescue (HDT-ASCT) remains the standard of care for patients with chemosensitive, relapsed diffuse large B-cell lymphoma (DLBCL). Because of concern for unacceptable toxicity and therefore inferior outcomes, geriatric patients (age >= 70) with relapsed DLBCL are typically not considered candidates for HDT-ASCT in clinical practice and have largely been excluded from clinical trials examining the role of HDT-ASCT with curative intention. There is a paucity of data in the transplant literature describing outcomes (with long-term follow up) of geriatric DLBCL patients undergoing HDT-ASCT in the relapsed-refractory setting.

Methods:
Utilizing Kaplan-Meier survival and Cox regression analyses, we conducted a two-center (John Theurer Cancer Center and Weill-Cornell Cancer Center) retrospective cohort study to evaluate the outcome of geriatric patients (age >= 70) with chemosensitive, relapsed-refractory DLBCL who underwent HDT-ASCT between 1994 and 2011. The primary study endpoint was overall survival (OS) assessed by chart review and SSDI database. As a secondary endpoint, we examined survival outcomes of geriatric patients with relapsed-refractory DLBCL who underwent HDT-ASCT in the rituximab era (transplant performed after year 2000).

Results:
75 geriatric patients with lymphoma (DLBCL 71%, MCL front-line consolidation in CR 11%, HL 5%, FCL 4%, PTCL 4%) were identified in our combined transplant outcomes database of which 52 underwent HDT-ASCT (n=40 JTCC, n=12 Cornell) for relapsed-refractory DLBCL representing 30 deaths and 1522 total months at risk (median follow up 18.4 months). Baseline characteristics included: median age at time of salvage and ASCT was 72, (range 70–86), ECOG PS 1 (range 0–2), ethnicity (90% caucasian), sex (65% male), hematopoietic cell transplant-co-morbidity (HCT CI) index score (median=1), conditioning regimen (BEAM 49%, BEAC 33%, 16% CBV, 2% Cy-TBI). With a median follow up of 18.4 months, the median OS for the entire cohort was 35.7 months with a 100 day mortality of 8.6% (95% CI 7.4–9.3%). The median OS for DLBCL patients who underwent HDT-ASCT in the rituximab era was 43 months (Figure). In univariate analysis, age (continuous variable, p=.15), patient sex (p=.9), HCT CI score (continuous variable, p=.4) were not associated with inferior survival.

Conclusions:
HDT-ASCT in a geriatric patient population is feasible with similar outcome as younger pts as shown by the following:

Disclosures:
Mato: Celgene: Speakers Bureau; Millennium: Speakers Bureau; Seattle Genetics: Speakers Bureau; Genentech: Speakers Bureau. Goy:Milennium: Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Celgene: Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; Pharmacyclics: Membership on an entity's Board of Directors or advisory committees; J & J: Membership on an entity's Board of Directors or advisory committees; Pfizer: Membership on an entity's Board of Directors or advisory committees. Feldman:Merck: Speakers Bureau; Seattle Genetics: Speakers Bureau; Celgene: Speakers Bureau; Allos: Speakers Bureau.