Autologous stem cell transplantation beyond 60 years of age

Abstract

Along with improved supportive care and thus reduced treatment-related mortality, an increasing number of elderly patients (460 years) with haematological malignancies are now considered for high-dose therapy (HDT) supported by autologous stem cell transplantation (ASCT). ASCT is feasible in selected elderly patients with multiple myeloma and those with non-Hodgkin's lymphoma. As elderly patients have generally been excluded from randomized studies evaluating efficacy of ASCT in comparison with non-transplant approaches, limited data are available on the efficacy of ASCT in this patient population. Recent developments in supportive care including amifostine and palifermin may increase feasibility of ASCT in elderly patients. Prospective studies are needed to evaluate feasibility and efficacy of ASCT in patients over 60 years of age. Also, further studies are needed in order to decrease toxicity of high-dose regimens in this patient group where co-morbid conditions may modify the toxicity of HDT in a clinically significant manner.

A retrospective study assessing the incidence, risk factors and comorbidities of pamidronate-related necrosis of the jaws in multiple myeloma patients

“…The finding of patient age as a significant risk factor is in agreement with Badros et al, who reported an increase in risk by 9% with each decade of life [12]. These authors interpreted this as a reflection of longer durations of bisphosphonate therapy although it is possible that changes in bone metabolism in the elderly may be an additional factor [12,18].…”

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

“…25 Advanced age is an independent risk factor for recurrent NHL; thus a higher percentage of older patients will be candidates for autologous SCT. 10 Advances in supportive care such as the introduction of peripheral blood stem cell grafts, growth factors, antibiotic prophylaxis, transfusion support and mucositis prevention have reduced the toxicity of transplantation. There are no conclusive data to recommend one conditioning regimen over another in this population.…”

“…[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. 9 CY, BCNU and etoposide has also been extensively used and is associated with cardiac toxicity.…”

Autologous stem cell transplantation in elderly patients (>=60 years) with diffuse large B-cell lymphoma: an analysis based on data in the European Blood and Marrow Transplantation registry

“…There may be ways to improve this. 26 In addition to patient selection, the conditioning regimen also appears to be important. Regimens based on total body irradiation have conventionally been used cautiously in elderly patients, which was also apparent in this registry analysis.…”