Influence of Age and Histology on Outcome in Adult Non-Hodgkin Lymphoma Patients Undergoing Autologous Hematopoietic Cell Transplantation (HCT): A Report from The Center For International Blood & Marrow Transplant Research (CIBMTR)

Received 15 July 2008; accepted 12 September 2008.

Abstract

To compare the clinical outcomes of older (age ≥55 years) non-Hodgkin lymphoma (NHL) patients with younger NHL patients (<55 years) receiving autologous hematopoietic cell transplantation (HCT) while adjusting for patient-, disease-, and treatment-related variables, we compared autologous HCT outcomes in 805 NHL patients aged ≥55 years to 1949 NHL patients <55 years during the years 1990–2000 using data reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). In multivariate analysis, older patients with aggressive histologies were 1.86 times (95% confidence interval [CI] 1.43-2.43, P < .001) more likely than younger patients to experience treatment-related mortality (TRM). Relative death risks were 1.33 times (CI 1.04-1.71, P = .024) and 1.50 times (CI 1.33-16.9, P < .001) higher in older compared to younger patients with follicular grade I/II and aggressive histologies, respectively. Autologous HCT in older NHL patients is feasible, but most disease-related outcomes are statistically inferior to younger patients. Studies addressing supportive care particular to older patients, who are most likely to benefit from this approach, are recommended.

Key Words: Non-Hodgkin lymphoma, Autologous HCT, Relapse, Second complete remission, Elderly

1 University Hospitals Case Medical Center, Cleveland, Ohio

2 Lymphoma Working Committee of the Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, Wisconsin

3 University of Waterloo, Waterloo, Ontario, Canada

4 University of Nebraska Medical Center, Omaha, Nebraska

5 Cleveland Clinic Foundation, Cleveland, Ohio

6 University of Texas Health Science Center, San Antonio, Texas

7 Center for Advanced Studies in Leukemia, Los Angeles, Californai

8 Royal Prince Alfred Hospital, Camperdown, Australia

9 St. Jude Children Research Center, Memphis, Tennessee

10 Mayo Clinic, Rochester, Minnesota

11 Texas Transplant Institute, San Antonio, Texas

12 South Florida Bone Marrow Stem Cell Institute, Boynton Beach, Florida

13 Bristol Children's Hospital, Bristol, United Kingdom

14 Tulane University Medical Center, New Orleans, Louisiana

15 Fundaleu, Buenos Aires, Argentina

16 University Hospitals Maastricht, Maastricht, The Netherlands

17 University of Chicago, Chicago, Illinois

18 Advocate Lutheran General Hospital, Park Ridge, Illinois

19 MD Anderson Cancer Research Center, Houston, Texas

20 Roswell Park Cancer Institute, Buffalo, New York

21 Shanxi Medical University, People's Republic of China

22 Newcastile Mater Hospital, Waratah, Australia

Correspondence and reprint requests: Hillard M. Lazarus, MD, Department of Medicine, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106.

Financial disclosure: See Acknowledgments on page 1332.

PII: S1083-8791(08)00398-4

doi:10.1016/j.bbmt.2008.09.008

5 of 21