Very low toxicity and good quality of life in 48 elderly patients autotransplanted for hematological malignancies : a single center experience

• Published in: Bone marrow transplantation (Basingstoke) Vol. 27; no. 11; pp. 1189 - 1195
• Main Authors: OLIVIERI, A, CAPELLI, D, TONNINI, C, LEONI, P, MONTANARI, M, BRUNORI, M, MASSIDDA, D, POLONI, A, LUCESOLE, M, CENTURIONI, R, CANDELA, M, MASIA, M. C
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.06.2001
• Subjects: Acute myeloid leukemia; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - toxicity; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone marrow, stem cells transplantation. Graft versus host reaction; Breast cancer; Busulfan; Chronic lymphocytic leukemia; Cyclophosphamide; Female; Graft Survival; Hematologic Neoplasms - complications; Hematologic Neoplasms - psychology; Hematologic Neoplasms - therapy; Hematology; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic Stem Cell Transplantation - methods; Hematopoietic Stem Cell Transplantation - standards; Hospitalization; Humans; Immunosuppressive agents; Leukemia; Leukocytes (neutrophilic); Lymphatic leukemia; Lymphoma; Male; Medical sciences; Melphalan; Middle Aged; Multiple myeloma; Non-Hodgkin's lymphoma; Patients; Platelets; Quality of life; Quality of Life - psychology; Stem cell transplantation; Surveys and Questionnaires; Survival Rate; Toxicity; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Transplantation, Autologous - adverse effects; Transplantation, Autologous - methods; Transplantation, Autologous - standards; Transplants & implants; Treatment Outcome; Antineoplastic agent; Toxicity; Stem cell; Hematopoietic cell; Blood; Autograft; Melphalan; Complication; Graft; Busulfan; Whole body; Pretreatment; High dose; Human; Drug combination; Alkanediol; Malignant hemopathy; Radiotherapy; Quality of life; Alkanesulfonic acid; Alkylating agent; Chemotherapy; Cyclophosphamide; Oxazaphosphinane derivatives; Treatment; Nitrogen mustard; Elderly
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1703034

Between May 1994 and May 2000, we autotransplanted 48 consecutive patients, 21 females and 27 males aged over 60 years (range: 60-78, median: 63). Sixteen patients had multiple myeloma (MM), 14 high-grade non-Hodgkin's lymphoma (HGNHL), six low-grade non-Hodgkin's lymphoma (LGNHL), nine acute myeloid leukemia (AML), one chronic lymphocytic leukemia (CLL), one Hodgkin's disease (HD) and one breast cancer; the performance status (WHO) was 0-1. Seventeen patients were in 1st CR (35.4%) and one in 2nd CR (2.1%), 25 in PR (52.1%), while five patients had been transplanted with progressive disease (10.4%); seven patients with MM received a double transplant. Patients received high-dose therapy including melphalan alone (13) or associated with other drugs (26), busulfan-cyclophosphamide (three), BEAM (11) and TBI (two). All patients took a median of 11 (range: 8-25) days to reach neutrophils >500/microl, 13 (range: 9-83) days to reach platelets > 20,000/microl and 17 (range: 11-83) days to reach platelets > 50,000/microl. Hematological toxicity, hospital stay and supportive care did not differ from those of a cohort of younger patients. At present, 31 patients are alive (14 in CR, five in PR, five in PD and seven in relapse) and 16 died from PD at a median follow-up of 37 months (1-67). Only one patient died from transplant-related toxicity. Quality of life, evaluated using a QLQ-C30 questionnaire in 25 patients at day +90, was good. In our experience PBPC mobilization and transplantation is feasible in patients aged > or = 60 years and the toxicity of this procedure is acceptable, with an early transplant-related mortality of 1.8%; therefore patients with hematological malignancies potentially curable with high-dose therapy (HDT) should also be candidates for HDT.