Allotransplantation for Patients Age >= 40 Years with Non-Hodgkin Lymphoma: Encouraging Progression-Free Survival

• Type of Material: Article
• Authors: Brian L. McClune, University of Minnesota; Kwang Woo Ahn, Medical College of Wisconsin; Hai-Lin Wang, Medical College of Wisconsin; Joseph H. Antin, Dana Farber Cancer Institute; Andrew S. Artz, University of Chicago; Jean-Yves Cahn, University Hospital, Grenoble; Abhinav Deol, Wayne State University; Cesar O. Freytes, South Texas Veterans Health Care System; Mehdi Hamadani, Medical College of Wisconsin; Leona A. Holmberg, Fred Hutchinson Cancer Research Center; Madan H. Jagasia, Vanderbilt University; Ann A. Jakubowski, Memorial Sloan Kettering Cancer Center; Mohamed A. Kharfan-Dabaja, University of South Florida; Hillard M. Lazarus, University Hospitals of Cleveland; Alan M. Miller, Baylor University; Richard Olsson, Karolinska University Hospital; Tanya L. Pedersen, Center for International Blood and Marrow Transplant Research; Joseph Pidala, University of South Florida; Michael A. Pulsipher, University of Utah; Edmund K Waller, Emory University
• Language: English
• Date: 2014-07-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 American Society for Blood and Marrow Transplantation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.bbmt.2014.03.013
• Title of Journal or Parent Work: Biology of Blood and Marrow Transplantation
• ISSN: 1083-8791
• Volume: 20
• Issue: 7
• Start Page: 960
• End Page: 968
• Grant/Funding Information: Complete funding list available in full text.; The CIBMTR is supported by Public Health Service Grant/Cooperative Agreement U24-CA76518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases (NIAID).; This project has been supported in part by funding from the National Marrow Donor Program and the Health Resources and Services Administration Contract No. HHSH234200637020C to the National Marrow Donor Program.
• Keywords: AUTOLOGOUS TRANSPLANTATION; Hematopoietic cell transplantation; MYELODYSPLASTIC SYNDROME; Lymphoma; REDUCED-INTENSITY; BONE-MARROW-TRANSPLANTATION; Reduced intensity; Transplantation; Science & Technology; ACUTE MYELOID-LEUKEMIA; OLDER PATIENTS; Nonmyeloablative; HEMATOPOIETIC-CELL TRANSPLANTATION; FOLLICULAR LYMPHOMA; ALLOGENEIC TRANSPLANTATION; LONG-TERM OUTCOMES; Life Sciences & Biomedicine; Elderly; Hematology; Allogeneic; Immunology
• Research Categories: Health Sciences, Oncology; Health Sciences, Medicine and Surgery

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.