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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

¹ Department of Medicine, Kuopio University Hospital, Kuopio, Finland
² Banc de Sang i Teixits, Barcelona, Spain
³ Divisione di Ematologia, Ospedale Bergamo, Bergamo, Italy
⁴ Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands
⁵ Hematology Department, H SS. Antonio e Biagio, Alessandria, Italy
⁶ Unitè de transplantation et de therapie cellulaire, Institut Paoli Calmettes, Marseille, France
⁷ Servicio de Hematologia-Hemoterapia, Hospital U. Marques de Valdecilla, Santander, Spain
⁸ Hematology, Centre Henri Becquerel, Rouen, France
⁹ Blood and Bone Marrow Transplant Centre, St. James’ University Hospital, Leeds, United Kingdom
¹⁰ Centre for Clinical Haematology, Birmingham, United Kingdom
¹¹ Division of Hematology, Az. Ospedaliera S. Croce e Carle, Cuneo, Italy
¹² Nottingham City Hospital, Nottingham, United Kingdom
¹³ Service d’Onco-Hématologie, Hopital l'Archet, Nice, France
¹⁴ Medizinische Klinik, University of Heidelberg, Heidelberg, Germany
¹⁵ Internal Medicine, University of Saarland, Homburg, Germany
¹⁶ Clinical Hematology Division, Hospital Santa Creu i Sant Pau, Barcelona, Spain

Correspondence: Esa Jantunen, MD, PhD, Department of Medicine, Kuopio University Hospital, P.O.B. 1777, 70211 Kuopio, Finland. E-mail:esa.jantunen{at}kuh.fi

Background: There is currently limited experience on the feasibility and efficacy of autologous stem cell transplantation in elderly patients with diffuse large B-cell lymphoma.

Design and Methods: We analyzed the outcome of 2612 patients with diffuse large B-cell lymphoma treated with autologous stem cell transplantation between 2000 and 2005 and reported to the European Blood and Marrow Transplantation registry. Four hundred and sixty-three patients (18%) were 60 years old at the time of the transplant (median, 63 years). When compared to 2149 patients <60 years old at the time of transplantation, the elderly patients had more frequently received at least two treatment lines (76% vs. 57%, p<0.001), were less commonly in first complete remission at the time of transplantation (23 % vs. 30 %, p=0.005) and received their transplants later after diagnosis (median time 14 months vs.7.5 months, p<0.001).

Results: Non-relapse mortality was higher in elderly patients at 100 days (4.4 % vs. 2.8 %), at 1 year (8.7% vs. 4.7%) and at 3 years (10.8% vs. 6.5%) (p=0.002). With a median follow-up of 12 months for the surviving patients for the elderly group and 15 months for the younger group, the risk of relapse was 38% and 32%, respectively (p=0.006).The progression-free survival was 51% and 62%, respectively, at 3 years (p<0.001). The overall survival rate was 60% vs. 70%, respectively, at 3 years (p<0.001).

Conclusions: Autologous stem cell transplantation is feasible in selected elderly patients with diffuse large B-cell lymphoma, although non-relapse mortality is somewhat higher than in younger patients. Both progression-free and overall survival rates are promising taking into account the generally poorer outcome of elderly patients with diffuse large B-cell lymphoma.

Key words: autologous stem cell transplantation, diffuse large B-cell lymphoma, elderly patients, non-relapse mortality, outcome.