High Dose Therapy and Autologous Stem Cell Transplantation Results in Good Outcomes and Acceptable Toxicities in Elderly Patients with Non-Hodgkin's Lymphoma

Background: High-dose therapy and autologous stem-cell transplantation (HDT-ASCT) can offer potential long-term remission or cure in patients with high risk non-Hodgkin’s lymphoma (NHL). Limited experience is available on the safety and efficacy of HDT-ASCT in elderly patients. Methods: This is a single-center, retrospective study examining outcomes of HDT-ASCT for NHL in 145 patients 60 years and older between January 2001 and December 2010. Clinical data and comorbidities were correlated with outcomes. Overall survival (OS) and progression-free survival (PFS) were analyzed according to age at transplant, histology, hematopoietic cell transplantation comorbidity index (HCT-CI) and first remission versus subsequent remission at the time of HDT-ASCT. Results: The median age was 65 (range 60-74). Fifty-nine, 67 and 20 patients were ages 60 - <65, 65 - <70 and >70, respectively. Patients underwent HDT-ASCT for diffuse large B-cell lymphoma (DLBCL, n=57, 39%), mantle cell lymphoma (MCL, n=53, 37%) and other NHL subtypes (n=35, 24%). HDT-ASCT in first remission was performed in 68 patients (47%), mostly with MCL (70%). BEAM and RR-BEAM were the most common conditioning regimens (85%). 34 (23%), 35 (24%) and 77 (53%) patients had a low (0), intermediate (1-2) and high (>3) HCT-CI score at transplant. Overall, with a median follow-up of 3.2 years (range 0.2-8.1) for survivors, PFS and OS at 2 years were 71% and 76%, respectively. Age and HCT-CI score did not affect OS or PFS. Patients with MCL had better outcomes compared to other NHL histologies with 2 years OS of 90% versus 65% and PFS of 85% versus 58% respectively. The one year incidence of progression was 4% in MCL, 28% in DLBCL and 34% for other NHL histologies. A total of 54 patients (37%) progressed [24 (44%) DLBCL, 14 (26%) MCL and 16 (30%) others]. Median time to treatment failure was 11.6 months (range 1.3-88). Three (2%) patients died from transplant complications. High-risk status by HCT-CI was not associated with TRM. Six patients (4%) developed secondary myelodysplastic syndrome (MDS) at a median of 40 months (range 5-83). Conclusion: In this large cohort of elderly patients with NHL who underwent HDT-ASCT, we demonstrate that this intervention is feasible, tolerable, and effective, and results in similar disease control and survival as in younger historical controls. Our data suggest that age alone is not predictive of post transplant outcomes and therefore should not be used to preclude HDT-ASCT in elderly.