INFLUENCE OF AGE ON THE OUTCOME OF 500 AUTOLOGOUS BONE-MARROW TRANSPLANT PROCEDURES FOR HEMATOLOGIC MALIGNANCIES

Purpose: To determine the effect of age on the outcome of autologous b one marrow transplantation (ABMT) and/or peripheral-blood progenitor-c ell (PBPC) transplantation. Patients and Methods: A retrospective anal ysis was performed on 500 consecutive patients who ranged in age from 1 to 65 years (median, 40) with non-Hodgkin's lymphoma (NHL), Hodgkin' s disease (HD), multiple myeloma (MM), or acute nonlymphoblastic leuke mia (AML) who underwent autologous hematopoietic-cell transplant proce dures at Stanford University Medical Center. Results: The actuarial 5- year event-free survivor (EFS) rate was 44%, the relapse rate 47%, and the regime-related mortality (RRM) rate 8.6%. Disease status at time of transplantation, categorized as either minimal or advanced disease, was the strongest predictive factor for EFS (relative risk [RR] for a dvanced-disease group. 1.8; P <.0003) and relapse rate (RR for advance d-disease group, 1.9; P <.0004). patients with minimal or advanced dis ease had an EFS rate of 48% and 30% and relapse rates of 43% and 72%, respectively. The EFS rate of patients less than 50 years verus greate r than or equal to 50 years of age was 46% versus 34% (P =.03), Cox re gression analysis showed that age was predictive for EFS (RR for patie nts 50 to 65 years, 1.4; P =.03), The actuarial RRM rate for these age groups was 7.4% versus 12.7% (P =.07), respectively. Multivariate ana lysis demonstrated that age (odds ratio [OR] for patients 50 to 65 yea rs, 1.9; P <.05) and period of transplantation (OR for most recent yea rs [1991 to 1995], 0.6; P =.06) were the most predictive factors for R RM. Conclusion: Although age greater than 50 years is associated with an inferior outcome following autologous hematopoietic-cell transplant ation, it does not appear to be warranted to limit this potentially cu rative procedure based solely on age. The upper age limit of high-dose therapy with autologous progenitor-cell and/ or bone marrow support r emains to be defined. (C) 1997 by American Society of Clinical Oncolog y.