In a nutshell
This study investigated the impact of older age on the outcomes of patients with non-Hodgkin’s lymphoma (NHL) who underwent allogeneic stem cell transplantation (alloSCT). This study concluded that alloSCT in patients older than 65 was associated with higher risks.
More than 60% of patients with NHL are older than age 60 at diagnosis. Many patients with NHL eventually fail first-line treatments and need more effective therapy. AlloSCT is a possible treatment option. This involves replacing the patient’s cancer cells with healthy stem cells that come from a donor. This requires high-dose chemotherapy first, to get rid of any remaining cancer cells.
AlloSCT treatment has mostly been used in patients who are younger than 60 and do not have additional medical conditions (comorbidities). The potential risks and benefits of alloSCT in elderly patients with NHL versus younger patients remain under investigation.
Methods & findings
This study involved 3919 patients with NHL. Patients were divided into groups based on age. 45.2% of patients were 50 or younger and 50.2% of patients were middle-aged (age 51 to 65). 4.59% of patients were 66 or older. 37% of patients had follicular lymphoma (FL), 30% of patients had diffuse large B cell lymphoma (DLBCL), and 21% of patients had mantle cell lymphoma (MCL). Patients were followed-up for an average of 4.5 years.
At 1 year, non-relapse mortality (death not due to cancer recurrence or progression; NRM) was significantly lowest in patients 50 or younger compared to middle-aged and patients older than 65 (13% vs. 20% and 33%). At 3 years, there was no significant difference in relapse rates between patients: 30% (50 or younger), 31% (middle-aged), and 28% (66 or older).
3-year overall survival (patients still alive 3 years later) was significantly higher in younger patients compared to middle-aged and older patients (62% vs. 53% and 41%). 3-year progression-free survival (patients still alive at 3 years without disease progression) was significantly higher in younger patients compared to middle-aged and older patients (51% vs. 42% and 29%).
The bottom line
This study concluded that alloSCT in patients with NHL older than 65 was associated with higher mortality. The authors suggest that although alloSCT is effective in these patients, this risk should be considered in treatment decisions.
The fine print
This study looked back at medical records. Information collected in this way is not always complete. Also, there was a significantly smaller number of patients in the group older than 65.
Published By :
Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation
Sep 15, 2018
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