Older patients with B-cell malignancies benefit from progression-free survival (PFS) and overall survival (OS) improvements after autologous stem cell transplantation (ASCT), according to research that will be presented at the 2017 ASCO Annual Meeting (June 2-6, 2017; Chicago, IL).
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Previous research has shown that high-dose chemotherapy regimens and ASCT results in durable remission in most patients with relapsed or high-risk Hodgkin or non-Hodgkin lymphoma. However, older patients (ages ≥ 70 years) are often not considered suitable for ASCT due to concerns of excess toxicity and increased-risk of mortality. Preliminary research suggests that ASCT may be feasible, safe, and effective in a select population of older patients.
Lova Sun, MD, Massachusetts General Hospital, and colleagues conducted a study to analyze the safety and efficacy of ASCT in older patients with multiple types of lymphoma. Researchers identified 199 patients ages 70 years and older with Hodgkin or non-Hodgkin lymphoma who underwent ASCT between 2000 and 2016 at either Massachusetts General Hospital or the Dana-Farber Cancer Institute (Boston, MA). Clinical characteristics recorded included lymphoma diagnosis, conditioning regimen, and outcomes regarding engraftment, treatment toxicities, and relapse. PFS and OS were measured using Kaplan-Meier survival analysis. Median follow-up for patients was 23 months.
Among the sample population, the most common lymphoma subtype was diffuse large B-cell (n = 75, 63%), followed by T-cell (n = 19), mantle cell (n = 12), follicular (n = 7), and Hodgkin (n = 6).
Researchers acknowledged that 3 patients experienced mortality within 100 days due to rapid disease progression (n = 1) or treatment toxicity (n = 2).
Results of the analysis showed that 2-year PFS and OS were 58% (95% CI, 48%-67%) and 66% (95% CI, 55%-74%), respectively. Disease relapse—which occurred in 33% of patients (n = 39)—was the leading cause of treatment failure. Two-year estimate for non-relapse mortality was 7% (95% CI, 3%-14%).
Authors of the study concluded that while risk of relapse and non-relapse mortality may be higher in older patients with lymphoma, ASCT is nonetheless a safe and effective options for such patients. “Eligibility for ASCT should be an individualized decision, and age should not be an absolute barrier to ASCT referral in healthy elderly patients with lymphoma,” the authors wrote.—Zachary Bessette
