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Leuk Res. 2019 Apr;79:75-80. doi: 10.1016/j.leukres.2019.01.002. Epub 2019 Jan 6.

Outcome of autologous hematopoietic stem cell transplant in older patients with B cell lymphoma when selected for fitness and chemosensitive disease.

Author information

1
Hôpital Maisonneuve-Rosemont, Division of Hematology, Oncology and Hematopoietic Stem Cell Transplantation, Hematopoietic Stem Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada.
2
Hôpital Maisonneuve-Rosemont, Division of Hematology, Oncology and Hematopoietic Stem Cell Transplantation, Hematopoietic Stem Cell Transplant Program, Université de Montréal, Montréal, Québec, Canada. Electronic address: silvy.lachance@umontreal.ca.

Abstract

BACKGROUND:

Autologous hematopoietic stem cell transplantation (AHSCT) in the older population is associated with an increased risk of morbidity and mortality. Determination of the hematopoietic cell transplant comorbidity index (HCT-CI) has contributed to improve patient selection while allowing prediction of their non-relapse mortality (NRM). The goal of this study was to identify factors influencing both safety and efficacy of AHSCT in an older non-Hodgkin lymphoma (NHL) population to better select those who will benefit from this intervention in the Canadian context of a single-payer government healthcare program.

METHODS:

This single center, retrospective study, examined clinical outcomes in 90 consecutive older patients (≥60 years old) with B-cell NHL treated with AHSCT between 2008 and 2014.

FINDINGS:

Median age was 63 (60-69) at time of transplantation. The HCT-CI risk score was low, intermediate and high in 34%, 40% and 26% of patients, respectively. NRM was 1% at 100 days and one-year post transplant and not influenced by age. At a median follow-up of 52 months, median progression-free survival (PFS) was 56 months while median overall survival (OS) was still not reached. Stable and progressive disease status at time of transplantation were associated with a lower PFS (HR 2.94) and OS (HR 3.91). BEAC conditioning and a graft cell dose  5 × 106 CD34+/kg led to faster recovery, decreased toxicity and resource consumption.

INTERPRETATION:

In the older population, AHSCT is safe and optimal when restricted to fit chemosensitive patients.

KEYWORDS:

Autologous HSCT; Non-Hodgkin lymphoma; Older; Outcome; Toxicity

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