High-dose myeloablative therapy and autologous peripheral blood progenitor cell transplantation for elderly patients (greater than 65 years of age) with relapsed large cell lymphoma

Abstract

Eleven elderly patients (older than 65 years) with relapsed large cell lymphoma were treated with high-dose myeloablative therapy and autologous peripheral blood progenitor cell support (ABMT). All 11 patients were in sensitive relapse at the time of ABMT. Treatment-related mortality was 9%. Median CD34 cell collection was 4.8 x 10(6) cells/kg. Median time to hematologic recovery was 11 days for granulocytes (range, 9 to 16 days) and 18 days for platelets (range, 14 to 42 days). Nine of 11 patients (81%) achieved a complete response following ABMT. Median time to treatment failure was 17 months. The 4-year disease-free and overall survival is projected to be 44%. When compared with a cohort of patients under age 65 years with sensitive relapsed large cell lymphoma treated with ABMT during the same time interval, disease-free and overall survival are comparable. ABMT is feasible, tolerable, and effective in elderly patients with relapsed large cell lymphoma with disease-free survival rates comparable to younger patients.

Autologous SCT with a dose-reduced BU and CY regimen in older patients with non-Hodgkin's lymphoma

“…There are no conclusive data to recommend one conditioning regimen over another in this population. [7][8][9]26 We have demonstrated that a modified BU and CY regimen in selected patients X60 years of age is well tolerated. The dose of BU has been reduced to 14 doses of 0.8 mg/kg i.v.…”

“…The 100-day transplant-related mortality was 9%. 9 The Mayo clinic series reported an event-free survival of 38% in 93 patients, 60-76 years old, who received SCT for NHL after conditioning with BEAC or BEAM. Transplant-related mortality was 5%.…”

“…One hundred-day mortality for patients between 60 and 70 years varies from 5 to 11% with an overall survival of 38-51%. [7][8][9] Several conditioning regimens for SCT have been described in older patients with NHL. 7,8,10 The BEAM regimen incorporates carmustine, etoposide, cytarabine and melphalan and has been associated with a treatmentrelated mortality of 9% in older patients.…”

“…7,8,10 The BEAM regimen incorporates carmustine, etoposide, cytarabine and melphalan and has been associated with a treatmentrelated mortality of 9% in older patients. 9 CY, BCNU and etoposide has also been extensively used and is associated with cardiac toxicity. 11 The regimen of BU and CY has been described extensively in several patient groups as a conditioning regimen for both autologous and allogeneic SCT for the treatment of hematologic malignancies.…”

Low transplant-related mortality with allogeneic stem cell transplantation in elderly patients

“…Our previous reports as well as data obtained from other transplant centers confirm that procedure-related toxicity and mortality may be reduced by using nonmyeloablative or reduced intensity conditioning prior to transplantation of allogeneic stem cells, while retaining the antitumor effects of alloreactive donor lymphocytes. 5,6,[8][9][10] Nevertheless, data regarding SCTrelated toxicity in elderly patients are scarce and focus more concentrated on autologous [11][12][13][14][15] than allogeneic SCT. 10,[16][17][18] In this report, we present our cumulative experience in elderly patients (X60 years) undergoing allogeneic SCT with RIC for hematological malignancies.…”