Study: Age Should Not Be a Determinant for HCT Eligibility in Non-Hodgkin Lymphoma

02/22/18

A study to be presented at the BMT Tandem Meetings (February 21-25, 2018; Salt Lake City, UT) found no difference in overall survival (OS) for patients aged 55-64 years compared with those aged 65 years and older with non-Hodgkin lymphoma (NHL) who underwent allogeneic hematopoietic stem cell transplantation (alloHCT).

AlloHCT has proven to be a potentially curative therapy for patients with NHL. However, its applicability to patients aged 65 years and older in the United States is limited because of the lack of Medicare coverage for this indication.

Nirav Shah, MD, assistant professor of medicine, division of hematology and oncology, Medical College of the University of Wisconsin, and colleagues conducted a multi-center retrospective study using the Center for International Blood and Marrow Transplant Research (CIBMTR) database to analyze outcomes of patients aged at least 65 years with NHL undergoing alloHCT. A total of 1629 patients—446 of whom were aged at least 65 years and 1183 of whom were aged 55-64 years—were sampled who underwent a first reduced-intensity conditioning alloHCT from 2008 through 2015 in the United States.

The primary outcome of the study was OS and secondary outcomes included progression-free survival (PFS), relapsed or refractory progression, and non-relapse mortality.

After a median follow-up of 48 months, researchers found no significant differences in OS (46% vs 51%, P = .07) and disease relapse or progression (42% vs 41%; P = .82) after alloHCT for patients in the 65 and older age group compared with those in the 55-64 age group, respectively.

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Additionally, no significant differences were observed in the cumulative incidence of grade 2-4 acute graft-versus-host disease after 180 days in the 55-64 age group (37%) and the 65 and older age group (35%; P = .38). The cumulative incidence of chronic graft-versus-host disease at 2 years was also comparable between the two patient groups (48% vs 45%, respectively; P = .25).

Authors of the study noted that the most common cause of death was relapse of primary disease in both patient groups.

"Age alone should not be a determining factor in the decision to refer older patients for transplant consultation to determine patient eligibility," concluded Dr Shah and colleagues.—Zachary Bessette