Comorbidities, not age, are predictive of survival after autologous hematopoietic cell transplantation for relapsed/refractory Hodgkin's lymphoma in patients older than 50 years

Ann Hematol. 2017 Jan;96(1):9-16. doi: 10.1007/s00277-016-2832-6. Epub 2016 Oct 18.

Abstract

Autologous hematopoietic cell transplantation (AHCT) is the standard of care for young patients with relapsed/refractory (R/R) Hodgkin's lymphoma (HL). However, there is limited experience of its efficacy and feasibility in older patients. The characteristics and outcomes of 121 patients aged ≥50 years (42 of them are ≥60 years old) with R/R HL who underwent AHCT were reviewed. After a median follow-up of 3.1 years, overall survival (OS) and progression-free survival (PFS) at 5 years were 64 and 55 %, respectively, with no differences between 50-59-year-old and ≥60-year-old patients. Hematological and extra-hematological toxicities after AHCT were comparable between the two groups of age. In univariate analysis, poorer OS and PFS were associated with disease status other than complete remission, hematopoietic cell transplantation comorbidity index (HCT-CI) scores >1, and Charlson Comorbidity Index (CCI) scores >1. HCT-CI scores >1 were also associated with a higher risk of grade 3-4 extrahematologic toxicity. In multivariate analysis, HCT-CI and CCI remained significantly associated with OS and PFS after adjustment for disease status. Our data show that AHCT can be performed in selected patients with R/R HL ≥50 years with acceptable outcome and toxicity. Comorbidities appear to impact AHCT outcome more than age.

Keywords: Autologous hematopoietic cell transplantation; Comorbidity; Elderly patients; Hodgkin’s lymphoma.

Publication types

  • Multicenter Study

MeSH terms

  • Age Factors
  • Aged
  • Comorbidity
  • Disease-Free Survival
  • Female
  • Hematopoietic Stem Cell Transplantation / mortality
  • Hematopoietic Stem Cell Transplantation / trends*
  • Hodgkin Disease / diagnosis*
  • Hodgkin Disease / mortality
  • Hodgkin Disease / therapy*
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnosis*
  • Neoplasm Recurrence, Local / mortality
  • Neoplasm Recurrence, Local / therapy*
  • Predictive Value of Tests
  • Retrospective Studies
  • Transplantation, Autologous / mortality
  • Transplantation, Autologous / trends
  • Treatment Outcome