Analysis of feasibility of myeloablative therapy and autologous peripheral stem cell (PBSC) transplantation in the elderly: an interim report

Abstract

Summary:An interim report evaluating the feasibility of myeloablative therapy followed by peripheral blood stem cell (PBSC) autotransplant in patients aged Ͼ60 years is presented. In the last 2 years 19 patients Ͼ60 years old with several oncological conditions, mostly hematological, underwent PBSC autotransplant either as salvage therapy following relapse or resistance to conventional treatment, or as consolidating therapy as a part of a well defined protocol. There were 13 males and six females; the mean age was 66.9 years (range 61-76 years); nine patients had resistant or relapsed lymphoma, six myeloma, two acute leukemia, one Waldenstrom's disease and one lung cancer. Myeloablative schemes included BEAM exclusively for lymphomas, busulfan and melphalan (Bu-MPH) mainly for myeloma, busulfan and cyclophosphamide (Bu-CTX) for lymphomas and leukemia and VP-16 and CTX for lung cancer. Mobilization of CD34 ϩ cells was achieved in all patients with the combination of high-dose CTX and G-CSF with collections between 2.83 to 19.04 × 10 6 /kg (mean 7.1). All patients engrafted with a median time for recovery of PMN (Ͼ0.5 × 10 3 / l) of 10 days (range 8-12 days) and for PLT (Ͼ20 × 10 3 / l) of 12 days (range 10-17 days). Major responses were obtained in 15 of 16 patients evaluable for response and eight patients entered CR; overall eight patients are in CR, five are alive with disease, five are dead from disease progression and one is dead because of congestive heart failure 7 months following PBSC autotransplant. No early deaths following the procedure occurred; major side-effects were grade I-II mucositis (58%), fever with documented sepsis (10%), pneumonia (5%), cardiac, renal and liver toxicity (5%). Cardiac function was evaluated before and after myeloablative therapy by VEF in all patients; no significant modifications were necessary. In conclusion, our experience demonstrates that myeloablative therapies in older selected patients can be feasible; the feasibility of introducing PBSC

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

“…Stamatoullas et al 16 transplanted two patients older than 65 years. Our analysis included four transplanted patients aged 66-70 years and Mazza et al 18 recently reported PBSCT in five NHL patients Ͼ65 years of age (67-76 years). While it may be concluded that PBSCT may be feasible in selected NHL patients aged up to 65 years, very limited published experience is available on this approach in NHL patients over 65 years of age.…”

Very low toxicity and good quality of life in 48 elderly patients autotransplanted for hematological malignancies: a single center experience

“…Median duration of neutropenia (ANC Ͻ0.1 ϫ 10 9 /l) was 6 days (range: 2-18); the ANC remained below 0.5 ϫ 10 9 /l for a median time of 8 days (range: [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] in all transplant procedures.…”

“…An EBMT survey reports transplant-related mortality 13% (TRM) in patients aged 55 years and over, transplanted for intermediate-high grade NHL, 10 but more recent data suggest that in the same setting, very low TRM can be achieved, using mobilized PBSC and conditioning regimens not including TBI. [7][8][9] Here, we report our single center experience in 48 patients aged Ͼ60 years (33% of these aged Ͼ65 years), autotransplanted with PBSC for hematological malignancies. …”

“…5,6 Extrahematological toxicity, performance status and age represent the main hurdles in using HDT in elderly patients. To date, very few reports concerning the use of HDT in elderly patients have been published [7][8][9] and ASCT is usually restricted in many centers to patients aged less than 50 or 60 years. An EBMT survey reports transplant-related mortality 13% (TRM) in patients aged 55 years and over, transplanted for intermediate-high grade NHL, 10 but more recent data suggest that in the same setting, very low TRM can be achieved, using mobilized PBSC and conditioning regimens not including TBI.…”

Blood and marrow transplantation in elderly acute myeloid leukaemia patients – older certainly is not better

“…Feasibility of this procedure in patients older than age 60 years has been demonstrated by a number of smaller reports investigating patients between the ages of 61-76 years, 34 61-68 years 35 and 61-65 years, 36 undergoing autologous stem cell transplant predominantly for multiple myeloma and nonHodgkin lymphoma (NHL). An acceptable TRM within the first 100 days of between 0 and 17% was noted in these elderly patient studies.…”