Allotransplantation for Patients Age %26gt;= 40 Years with Non-Hodgkin Lymphoma: Encouraging Progression-Free Survival

作者：McClune Brian L; Ahn Kwang Woo; Wang Hai Lin; Antin Joseph H; Artz Andrew S; Cahn Jean Yves; Deol Abhinav; Freytes Cesar O; Hamadani Mehdi; Holmberg Leona A; Jagasia Madan H; Jakubowski Ann A; Kharfan Dabaja Mohamed A; Lazarus Hillard M; Miller Alan M; Olsson Richard; Pedersen Tanya L; Pidala Joseph; Pulsipher Michael A; Rowe Jacob M; Saber Wael; van Besien Koen W; Waller Edmund K; Aljurf Mahmoud D; Akpek Goergun; Bacher Ulrike; Chao Nelson J

来源：Biology of Blood and Marrow Transplantation, 2014, 20(7): 960-968.

DOI：10.1016/j.bbmt.2014.03.013

• Reduced intensity
• Nonmyeloablative
• Allogeneic
• Hematopoietic cell transplantation
• Elderly
• Lymphoma

Non-Hodgkin lymphoma (NHL) disproportionately affects older patients, who do not often undergo allogeneic hematopoietic cell transplantation (HCT). We analyzed Center for International Blood and Marrow Transplant Research data on 1248 patients age %26gt;= 40 years receiving reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT for aggressive (n = 668) or indolent (n = 580) NHL Aggressive lymphoma was more frequent in the oldest cohort 49% for age 40 to 54 versus 57% for age 55 to 64 versus 67% for age %26gt;= 65; P = .0008). Fewer patients aged %26gt;= 65 had previous autografting (26% versus 24% versus 9%; P = .002). Rates of relapse, acute and chronic GVHD, and nonrelapse mortality (NRM) at 1 year post-HCT were similar in the 3 age cohorts (22% [95% confidence interval (CI), 19% to 26%] for age 40 to 54, 27% [95% CI, 23% to 31%] for age 55 to 64, and 34% [95% CI, 24% to 44%] for age %26gt;= 65. Progression-free survival (PFS) and overall survival (OS) at 3 years was slightly lower in the older cohorts (OS: 54% [95% CI, 50% to 58%] for age 40 to 54; 40% [95% CI, 36% to 44%] for age 55 to 64, and 39% [95% CI, 28% to 50%] for age %26gt;= 65; P %26lt; .0001). Multivariate analysis revealed no significant effect of age on the incidence of acute or chronic GVHD or relapse. Age %26gt;= 55 years, Karnofsky Performance Status %26lt;80, and HLA mismatch adversely affected NRM, PFS, and OS. Disease status at HCT, but not histological subtype, was associated with worse NRM, relapse, PFS, and OS. Even for patients age %26gt;= 55 years, OS still approached 40% at 3 years, suggesting that HCT affects long-term remission and remains underused in qualified older patients with NHL.

• 出版日期2014-7