Mortality Increases With Patient Age After Allogenic Hematopoietic Cell Transplantation for Non-Hodgkin Lymphoma

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Mortality and relapse incidence were assessed in patients with non-Hodgkin lymphoma after allogeneic hematopoietic cell transplantation (alloHCT).
Mortality and relapse incidence were assessed in patients with non-Hodgkin lymphoma after allogeneic hematopoietic cell transplantation (alloHCT).

Older age may be an independent risk factor for mortality in patients with non-Hodgkin lymphoma (NHL) after allogeneic hematopoietic cell transplantation (alloHCT), according to a study published in Biology of Blood and Marrow Transplantation.

This retrospective study analyzed data from 3919 patients who had received an alloHCT for NHL and were registered with the European Society for Blood and Marrow Transplantation. Patients were categorized according to age: young, 18-50 years old; middle age, 51-65 years old; and old (O), 65-77 years old. Engraftment and incidence of graft-versus-host disease (GVHD), relapse incidence (RI), progression-free survival (PFS), 1-year non-relapse mortality (NRM), and overall survival (OS) were assessed.

The cumulative incidences of engraftment at day 100 were 97% for young patients, 97% for middle age patients, and 92% for old patients (P =.02). No differences were seen among the groups for cumulative incidences of acute (27%, 29%, and 24% for young, middle age, and old patients, respectively [P =.48]) or chronic GVHD (49% for all age groups, P =.98).

The 1-year NRM rates were 13% for young patients, 20% for middle age patients, and 33% for old patients (P <.001). After 3 years, the RI for young, middle age, and old cohorts were 30%, 31%, and 28% (P =.36), respectively, while the OS was found to be 60%, 54%, and 38%, respectively (P <.001). PFS was found to be 51%, 42%, and 29% for young, middle age, and old cohorts, respectively (P <.01). The authors also adjusted for confounding effects, which confirmed that older age was a significant predictor for NRM and OS (P <.001 for both) but not for RI (P =.80). Comorbidity was also a significant predictor for NRM, PFS, and OS, but the main effect of age remained unchanged (P =.04).

“Although alloHCT is feasible and effective in very old patients, the increased NRM risk has to be taken into account,” concluded the authors.

Reference

1. Kyriakou C, Boumendil A, Finel H, et al. The impact of advanced patient age on mortality after allogeneic hematopoietic Cell Transplantation for Non-Hodgkin's Lymphoma: A retrospective study by the EBMT Lymphoma Working Party [published online September 13, 2018]. Biol Blood Marrow Transplant. doi:10.1016/j.bbmt.2018.08.025

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