A retrospective study identified high risk for toxic effects in older patients with lymphoma treated with high-dose chemotherapy and autologous hematopoietic cell transplantation (AHCT). These findings were published in Blood Advances.

The use of high-dose chemotherapy and AHCT among an older patient population has not been evaluated sufficiently. This retrospective analysis aimed to assess whether this combination therapy associated with high risk for toxicity or mortality.

In this study, 346 patients aged 60 years and older with non-Hodgkin lymphoma (NHL) treated with carmustine, etoposide, cytarabine, and melphalan (BEAM) and AHCT at Memorial Sloan Kettering Cancer Center between 2000 and 2018 were retrospectively reviewed for outcomes.


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Patient characteristics included 34% women, median age 65.8 years (range, 60 to 77); 39.3% had diffuse large B-cell lymphoma, 34.4% had mantle cell lymphoma, 17.6% had T-cell NHL, and 6.1% had follicular lymphoma.

All but 23 patients had grade 3 or higher toxicities from 7 days prior to 100 days post-AHCT. Patients aged 60 to 69 years had a median number of 2 events (range, 0 to 10) and patients aged 70 years and older had 3 events (range, 1 to 13).

Cardiovascular toxicity was more likely among the older cohort (adjusted hazard ratio [aHR], 3.39; 95% CI, 2.26-5.10) and among patients with low absolute lymphocyte count (<0.5 K/µL; HR, 1.63; 95% CI, 1.11-2.39) and pre-AHCT albumin (<4.10 g/dL; HR, 1.80; 95% CI, 1.23-2.63). Oral or gastrointestinal toxicity risk was increased among patients with a low CD34 stem cell dose (<5.05×106 cells/kg; HR, 1.75; 95% CI, 1.30-2.35).

The median progression-free survival was 8.32 years (95% CI, 6.10-13.22) and overall survival was 10.45 years (95% CI, 8.24-13.22).

This study may have been limited by its retrospective design and limited sample size.

These data indicated that older patients receiving BEAM and AHCT for NHL were at high risk for toxicity events.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Dahi PB, Lee J, Devlin SM, et al. Toxicities of high-dose chemotherapy and autologous hematopoietic cell transplantation in older patients with lymphoma. Blood Adv. 2021;5(12):2608-2618. doi:10.1182/bloodadvances.2020004167