Peripheral blood stem cell transplantation as front-line therapy in patients aged 61 to 65 years: a pilot study

Abstract

Summary:The aim of the present trial was to investigate the feasibility of high-dose therapy followed by autologous peripheral blood stem cell transplantation (PBSCT) as a component of front-line treatment in patients with disseminated intermediate-and high-grade non-Hodgkin's lymphoma (NHL) aged 61-65 years. From October 1993 to June 1996, 14 consecutive patients entered this singlecenter prospective pilot trial. Patients were five males and nine females, median age 63 (range 61-65). The first-line treatment consisted of three courses of CHOP therapy. Patients achieving either a partial response (PR) or a complete response (CR) after initial therapy were eligible for PBSCT, while those with refractory or progessive disease were not autografted but included in the feasibility study in an intent-to-treat analysis. Of the 14 patients, 11 achieved either a CR (one) or a PR (10) after three courses of CHOP while the three patients with no response were not autografted and subsequently died of progressive disease. PBSC collection was feasible in responding patients after G-CSF priming (10 g/kg/day for 6 days). Conditioning therapy was the BEAM protocol. All patients engrafted after PBSCT. The median time to granulocyte (Ͼ0.5 × 10 9 /l) and platelet recovery (Ͼ25 × 10 9 /l) was 12 (range 9-18) and 13 days (range 7-22), respectively. No toxic deaths VOD or IP were observed. Four of the 11 responding patients relapsed 2, 7, 9 and 12 months after PBSCT, respectively, and all died from progressive disease. Overall, 7/14 patients are alive and free from disease, 16-43 months after initial diagnosis (median 28). The actuarial overall survival is 45.7 %, and the actuarial event-free survival is 50% at 3.5 years. This study shows the feasibility of high-dose therapy and PBSCT in patients with intermediate-or high-grade disseminated NHL aged 61-65 years. Such patients should not be excluded from trials evaluating the role of ASCT as part of initial treatment for disseminated and histologically aggressive NHL.

Peripheral Blood Stem Cell Transplantation in Patients Over 65 Years Old with Malignant Lymphoma-Possibility of Early Completion of Chemotherapy and Improvement of Performance Status-

“…Recently, despite the small number of cases, French groups have reported PBSCTtrials with elderly NHL patients. Hematopoietic recovery was similar to that observed in younger patients, and transplant-related toxicity appeared to be acceptable (17,18). Age itself does not appear to impair PBSCT.For this reason, we performed PBSCTfor PR patients older than 65 years.…”

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

“…[9][10][11][12][13] However, few reports focus on the use of high-dose myeloablative therapy, and these address only the use of PBSC autotransplants in lymphomas 6,9,10 or myelomas. 7 In the last 9 years the introduction of PBSC technology has contributed to the enormous increase in the number of autotransplants carried out each year.…”

“…25 This concept is now largely accepted, but in our set of patients it was difficult to apply, due to prior therapy and the possibility of increased toxicity. We believe that the use of myeloablative therapy as front-line treatment as shown in the article of Moreau et al 10 could be acceptable and feasible in patients older than 65 years with a good performance status. Experience in multiple myeloma with the use of myeloablative therapy is now mature 7,26 and most trials are including patients up to 60 years of age but generally not exceeding 65 years.…”

“…These reports describe experiences with patients with relapsed or resistant lymphomas treated with myeloablative therapy as salvage treatment 9 and those where it was used as part of front-line therapy. 10 The myeloablative protocol was BEAM. A major difference between the two reports was that the patients selected for myeloablative therapy as up-front treatment were between ages 60 and 65 years, whereas resistantrefractory patients had an age range of between 61 and 72 years which is similar to our experience.…”

“…[1][2][3][4][5][6][7] Nevertheless most reports focus on patients younger than 60 years due to higher procedurerelated risk in older patients. [6][7][8] Few reports concerning the use of high-dose therapy and autologous bone marrow 6,8 or peripheral stem cell transplantation 9,10 in the elderly are available, although growing interest in treating older patients has been shown. 11,12 In addition, from an epidemiological point of view, more than 50% of hematological neoplasms are diagnosed in the elderly.…”