Peripheral stem cell mobilization and engraftment in patients over age 60

Summary:Limited data are available concerning feasibility and toxicity of progenitor cell mobilization and high-dose therapy (HDT) supported by peripheral blood stem cell transplantation (PBSCT) in elderly patients (у60 years) with non-Hodgkin's lymphoma (NHL). From 1995 to 1999, 17 elderly NHL patients (median age 63 years, range 60-70) entered our HDT program and were mobilized with CY (4 g/m 2 ) followed by G-CSF. Mobilization was successful in 13 patients, who then received BEAM or BEAC followed by PBSCT. The feasibility and toxicity of progenitor cell mobilization and HDT in the elderly patients were compared with experiences in 62 NHL patients Ͻ60 years (median 46 years, range 16-59), who received the same mobilization protocol and of whom 48 patients received HDT supported by PBSCT. No significant differences were observed between these groups in the success rate of progenitor cell mobilization, in the number of CD34-positive cells collected or in the number of aphereses needed. HDT appeared to be somewhat more toxic in the elderly patients: a higher peak CRP value (P = 0.08) and longer in-hospital stay (P = 0.05) were observed. No differences were found in transplant-related mortality or severe organ toxicity between these age groups except for oral mucositis grade Ͼ2, which tended to be more common in the elderly patients (P = 0.07). We conclude that progenitor cell mobilization and HDT supported by PBSCT is also feasible in selected elderly patients with NHL. Bone Marrow Transplantation (2000) 26, 737-741.

Section: Discussionsupporting

confidence: 82%

Feasibility and toxicity of high-dose chemotherapy supported by peripheral blood stem cell transplantation in elderly patients (⩾60 years) with non-Hodgkin’s lymphoma: comparison with patients <60 years treated within the same protocol

Jantunen

Mahlamäki

Nousiainen

2000

“…Transplant-related non-hematological toxicity was surprisingly not excessive in our elderly patients although one would perhaps expect a higher incidence due to more compromised organ function in this older population. 16 In our study the findings that multiple cycles of standard-dose chemotherapy may be connected with worse outcome of HDC, 12,17 were not confirmed. The clinical outcome of patients receiving more or less intensive first-line therapy was similar.…”

Section: Discussioncontrasting

confidence: 41%

Causative factors for prolonged hospitalization beyond the point of engraftment in patients after autologous peripheral blood stem cell transplantation

Cetkovský

Škopek

Schützová

2000

Summary:In order to assess the incidence and analyze reasons which cause prolongation of hospital stay in patients engrafted after peripheral blood stem cell transplantation (PBSCT), we performed this retrospective analysis. One hundred patients (receiving 123 conditioning regimens) were included in the analysis. Criteria for discharge were presence of myeloid engraftment and absence of severe concomitant problems. Ninety subjects (73%) were discharged just after engraftment was reached on day +12 (10-14). Discharge was delayed in 33 patients (27%) and the mean prolongation was 3 days (1-11). In 31 patients (25%) delayed discharge was due to complications: in 14 patients (11.4%) because of GIT problems, in 16 patients (13%) because of infectious complications and in one patient because of cardiotoxicity. A significantly higher number of infectious complications was found in patients conditioned with BEAM (19.7% vs 4.2%, P Ͻ 0.05) while GIT toxicity was the most common reason for discharge delays in patients conditioned with melfalan 200 mg/m 2 (8.2% vs 14.7%, NS). No risk factors of hospital stay prolongation were determined. We conclude that in spite of rapid engraftment, non-hematological toxicities and infections remain important limitations for further reduction of the length of patient hospitalization in a significant number of patients after PBSCT. Bone Marrow Transplantation (2000) 26, 877-880.

“…Stem cell collection and intensification were performed as in younger patients, as has been previously reported. 21 However, the freedom from progression was significantly shorter than in younger patients. We observed a trend (P = 0.09) towards a more prolonged OS in younger patients.…”

mentioning

confidence: 95%

Reduced progression-free survival in elderly patients receiving intensification with autologous peripheral blood stem cell reinfusion for multiple myeloma

Dumontet

Ketterer

Espinouse

et al. 1998

Summary:Between 1990 and 1997, 55 patients with high risk multiple myeloma underwent high-dose therapy with peripheral blood stem cell transplantation. Intensification consisted of high-dose L-PAM in 54 patients, and 15 patients underwent a second high-dose treatment. Thirty patients received total body irradiation. Twenty patients were more than 60 years old. Thirty-five patients were intensified during first response. The overall response rate was 78%. There were four toxic deaths. The median overall survivals after intensification and after first treatment of myeloma were greater than 48 months and 71 months, respectively. Conversely freedom from progression after intensification was short, with a median of 22 months. Freedom from progression was significantly shorter in patients older than 60 (12 months), and in patients who had received more than 75 mg/m 2 of L-PAM before intensification (16 months). Although intensification is feasible in elderly patients the benefit appears to be reduced in this subgroup of patients. Prior therapy with high cumulative doses of L-PAM should be avoided in patients who will receive high-dose L-PAM for therapeutic intensification. Keywords: myeloma; elderly; L-PAM; PBSC The alkylating agents L-PAM and cyclophosphamide were the first agents to significantly increase the median survival in patients with high risk myeloma, from 7 to 30 months after diagnosis. The administration of high-dose L-PAM, alone or with growth factors and/or stem cell support has yielded encouraging results in a number of non-randomized series, with higher response rates, including a large fraction of complete or very good partial responses. at 5 years vs 12%) than the use of standard-dose chemotherapy.A major concern with the use of bone marrow grafts is the potential role played by contaminating myeloma cells in relapse. Various authors have advocated the use of peripheral blood stem cells (PBSC) for bone marrow reconstitution, in order to limit tumor cell contamination and to shorten the cytopenic period.6,7 Recent reports have analyzed the use of positively selected CD34(+) stem cells. 8,9 Ongoing trials using CD34(+) stem cells are currently under way.We report the results of therapeutic intensification in 55 myeloma patients treated at the Centre Hospitalier Lyon Sud over a 6-year period. The majority of patients had chemosensitive disease, and 36% were 60 years old or more at the time of intensification. Fifteen patients underwent double intensification. A number of disease-or treatmentrelated factors were analyzed for their potential influence on overall and progression-free survival. Patients and methods Patient characteristicsBetween January 1990 and September 1997, 55 patients received high-dose intravenous L-PAM, with or without total body irradiation (TBI) for multiple myeloma. Patient and treatment characteristics are shown in Table 1. There were 31 males and 24 females. The median age at intensification was 58 years (range 25-66, and 20 patients were 60 years old or more). Nine patients ha...