Allotransplantation for patients age ≥40 years with non-Hodgkin lymphoma: Encouraging progression-free survival Journal Article

Authors: McClune, B. L.; Ahn, K. W.; Wang, H. L.; Antin, J. H.; Artz, A. S.; Cahn, J. Y.; Deol, A.; Freytes, C. O.; Hamadani, M.; Holmberg, L. A.; Jagasia, M. H.; Jakubowski, A. A.; Kharfan-Dabaja, M. A.; Lazarus, H. M.; Miller, A. M.; Olsson, R.; Pedersen, T. L.; Pidala, J.; Pulsipher, M. A.; Rowe, J. M.; Saber, W.; van Besien, K. W.; Waller, E. K.; Aljurf, M. D.; Akpek, G.; Bacher, U.; Chao, N. J.; Chen, Y. B.; Cooper, B. W.; Dehn, J.; De Lima, M. J.; Hsu, J. W.; Lewis, I. D.; Marks, D. I.; McGuirk, J.; Cairo, M. S.; Schouten, H. C.; Szer, J.; Ramanathan, M.; Savani, B. N.; Seftel, M.; Socié, G.; Vij, R.; Warlick, E. D.; Weisdorf, D. J.
Article Title: Allotransplantation for patients age ≥40 years with non-Hodgkin lymphoma: Encouraging progression-free survival
Abstract: Non-Hodgkin lymphoma (NHL) disproportionately affects older patients, who do not often undergo allogeneic hematopoietic cell transplantation (HCT). We analyzed Center for International Blood and Marrow Transplant Research data on 1248 patients age ≥40 years receiving reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT for aggressive (n = 668) or indolent (n = 580) NHL. Aggressive lymphoma was more frequent in the oldest cohort 49% for age 40 to 54 versus 57% for age 55 to 64 versus 67% for age ≥65; P =.0008). Fewer patients aged ≥65 had previous autografting (26% versus 24% versus 9%; P =.002). Rates of relapse, acute and chronic GVHD, and nonrelapse mortality (NRM) at 1 year post-HCT were similar in the 3 age cohorts (22% [95% confidence interval (CI), 19% to 26%] for age 40 to 54, 27% [95% CI, 23% to 31%] for age 55 to 64, and 34% [95% CI, 24% to 44%] for age ≥65. Progression-free survival (PFS) and overall survival (OS) at 3 years was slightly lower in the older cohorts (OS: 54% [95% CI, 50% to 58%] for age 40 to 54; 40% [95% CI, 36% to 44%] for age 55 to 64, and 39% [95% CI, 28% to 50%] for age ≥65; P <.0001). Multivariate analysis revealed no significant effect of age on the incidence of acute or chronic GVHD or relapse. Age ≥55 years, Karnofsky Performance Status <80, and HLA mismatch adversely affected NRM, PFS, and OS. Disease status at HCT, but not histological subtype, was associated with worse NRM, relapse, PFS, and OS. Even for patients age ≥55 years, OS still approached 40% at 3 years, suggesting that HCT affects long-term remission and remains underused in qualified older patients with NHL. © 2014 American Society for Blood and Marrow Transplantation.
Keywords: adult; cancer survival; middle aged; major clinical study; overall survival; busulfan; cancer recurrence; cytarabine; methotrexate; progression free survival; etoposide; melphalan; carmustine; thiotepa; acute graft versus host disease; chronic graft versus host disease; nonhodgkin lymphoma; nonmyeloablative conditioning; whole body radiation; karnofsky performance status; lymphoma; graft versus host reaction; reduced intensity conditioning; t cell depletion; tacrolimus; bone marrow transplantation; elderly; cyclosporin; allotransplantation; reduced intensity; hematopoietic cell transplantation; allogeneic; human; male; female; article; nonmyeloablative
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 20
Issue: 7
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2014-07-01
Start Page: 960
End Page: 968
Language: English
DOI: 10.1016/j.bbmt.2014.03.013
PROVIDER: scopus
PMCID: PMC4057955
PUBMED: 24641829
Notes: Biol. Blood Marrow Transplant. -- Cited By (since 1996):2 -- Export Date: 8 July 2014 -- CODEN: BBMTF -- Source: Scopus
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