Autologous stem cell transplantation for patients aged 60 years or older with refractory or relapsed classical Hodgkin’s lymphoma: a retrospective analysis from the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC)

Stamatoullas, Aspasia; Brice, Pauline; Gueye, Mor Sény; Mareschal, Sylvain; Chevallier, Patrice; Bouabdallah, Réda; Nguyen-Quoc, Stéphanie; François, Sylvie; Turlure, Pascal; Céballos, Patrice; Monjanel, Hélène; Bourhis, J.; Guillerm, Gaëlle; Mohty, Mohamad; Biron, Pierre; Cornillon, Jérôme; Belhadj, Karim; Bonmati, Caroline; Ms, Dilhuydy; Huynh, Anne; Bernard, Marc; Chrétien, M-L; Latour, Régis Peffault de; Tilly, Hervé

doi:10.1038/bmt.2016.76

Cited by 11 publications

(6 citation statements)

References 23 publications

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“…Two recent retrospective studies have looked at the feasibility of this approach in older patients. In a French cohort, 6.6% of older patients died within 3 months of ASCT from toxic events including organ failure and pneumonia (77). With a median follow-up of 54 months, 5-year estimates of OS and PFS for the entire group were 67 and 54%, respectively.…”

Section: Relapsed/refractory Diseasementioning

confidence: 99%

Older patients with Hodgkin Lymphoma: Walking the tightrope of efficacy and toxicity

Barrett

Collins

2023

Front. Oncol.

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Since its initial description, classical Hodgkin lymphoma (cHL) portends a greatly improved prognosis and the goal of treatment in most patients is cure with minimisation of toxicity from treatment. Outcomes in older patients (>60 years old) lag behind those of their younger counterparts however, and cure remains achievable mostly for those who can tolerate full doses of conventional chemotherapy. This review addresses the difference in biology between younger and older patients with cHL and examines the impact of frailty and comorbidities on outcomes. The toxicities of conventional chemotherapy in anthracycline-fit and -unfit patients are examined, with a particular focus on pulmonary toxicity associated with bleomycin in older patients. New advances are discussed, including the possibility of using more targeted therapies such as the anti-CD30 antibody brentuximab vedotin (BV) and checkpoint inhibitors as a method of reducing dependency on conventional chemotherapy for those less well able to tolerate it. Treatment of older patients with cHL remains an area of unmet need in hematological research, and efforts to rectify this knowledge gap should continue.

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Section: Relapsed/refractory Diseasementioning

confidence: 99%

Older patients with Hodgkin Lymphoma: Walking the tightrope of efficacy and toxicity

Barrett

Collins

2023

Front. Oncol.

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“…We must assume that they were fit and without significant comorbidities, making these findings unreproducible to a general population of elderly HL. A French group retrospectively analyzed 128 fit patients (autographed by BEAM regimen (BCNU, cytarabine, etoposide and melphalan) [ 79 ]. The most common AE grade III or IV was mucositis (N = 13), while other toxicities of interest were sepsis (N = 3) and pneumonitis (N = 3).…”

Section: Relapsed/refractory Setting In Elderly Suffering From Hodgki...mentioning

confidence: 99%

Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review

et al. 2022

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Elderly patients make up a significant number of cases of newly diagnosed Hodgkin lymphoma. However, unlike in young patients, the outcomes of elderly patients are poor, and they are under-represented in phase III trials. Prior to treatment initiation, geriatric assessment should ideally be performed to address the patient’s fitness and decide whether to pursue a curative or palliative approach. The ABVD regimen is poorly tolerated in unfit patients, with high treatment-related mortality. Alternative chemotherapy approaches have been explored, with mixed results obtained concerning their feasibility and toxicity in phase II trials. The introduction of brentuximab vedotin-based regimens led to a paradigm shift in first- and further-line treatment of elderly Hodgkin lymphoma patients, providing adequate disease control within a broader patient population. As far as checkpoint inhibitors are concerned, we are only just beginning to understand the role in the treatment of this population. In relapsed/refractory settings there are few options, ranging from autologous stem cell transplantation in selected patients to pembrolizumab, but unfortunately, palliative care is the most common modality. Importantly, published studies are frequently burdened with numerous biases (such as low numbers of patients, selection bias and lack of geriatric assessment), leading to low level of evidence. Furthermore, there are few ongoing studies on this topic. Thus, elderly Hodgkin lymphoma patients are hard to treat and represent an unmet need in hematologic oncology. In conclusion, treatment needs to be personalized and tailored on a case-by-case basis. In this article, we outline treatment options for elderly Hodgkin lymphoma patients.

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“…The risk of morbidity and mortality is higher in older AHCT recipients as compared to younger AHCT recipients in some studies, whereas other studies demonstrate similar outcomes in older versus younger patients . Recent advances in HCT strategies with improved supportive care have resulted in reduction in nonrelapse mortality (NRM) and increased use of HCT in older recipients (>60 years of age) . Despite these advancements, the true burden of morbidity suffered by the elderly population after AHCT is still unknown.…”

Section: Introductionmentioning

confidence: 99%

Transplantation related toxicity and mortality in older autologous hematopoietic cell transplantation recipients

et al. 2017

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With advances in supportive care, autologous hematopoietic cell transplant (AHCT) is increasingly being performed for patients older than 60 years. We analyzed patients receiving an AHCT for multiple myeloma or lymphoma in a contemporary cohort (2010–2012), with consistent treatment and supportive care and compared outcomes [CTCAE grade 3–5 toxicities, non-relapse mortality (NRM) and overall-survival (OS)] of younger (40–59 years, n=77) versus older (≥60 years, n=67) recipients. The proportion of patients with neutropenic infections was higher in the older group (64% vs. 44%; p=0.02). The proportion of patients with any grade 3–5 toxicity was also higher in the older group (84% vs. 67%, p=0.03). In multivariate analysis, older age was significantly associated with higher odds (OR: 2.57, 95% CI:1.09–6.05) of grade 3–5 toxicity. The NRM was 3% (older) vs. 0% (younger) at one-year. The probability of OS at 2–years was lower in the older group (76% vs. 90%, p=0.04). Though AHCT can be performed safely in older recipients, the higher toxicity and slightly higher NRM in this population needs attention. Studies focusing on risk-stratification in older patients would further help predict toxicity. Further studies addressing enhanced supportive care needs for older patients who are most likely to benefit are indicated.

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Autologous stem cell transplantation for patients aged 60 years or older with refractory or relapsed classical Hodgkin’s lymphoma: a retrospective analysis from the French Society of Bone Marrow Transplantation and Cell Therapies (SFGM-TC)

Cited by 11 publications

References 23 publications

Older patients with Hodgkin Lymphoma: Walking the tightrope of efficacy and toxicity

Older patients with Hodgkin Lymphoma: Walking the tightrope of efficacy and toxicity

Clinical Dilemmas in the Treatment of Elderly Patients Suffering from Hodgkin Lymphoma: A Review

Transplantation related toxicity and mortality in older autologous hematopoietic cell transplantation recipients

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