Analysis of feasibility of myeloablative therapy and autologous peripheralstem cell (PBSC) transplantation in the elderly: an interim report

An interim report evaluating the feasibility of myeloablative therapy follo wed by peripheral blood stem cell (PBSC) autotransplant in patients aged >6 0 years is presented, In the last 2 years 19 patients >60 years old with se veral oncological conditions, mostly hematological, underwent PBSC autotran splant either as salvage therapy following relapse or resistance to convent ional treatment, or as consolidating therapy as a part of a well defined pr otocol. There were 13 males and six females; the mean age was 66.9 years (r ange 61-76 years); nine patients had resistant or relapsed lymphoma, six my eloma, two acute leukemia, one Waldenstrom's disease and one lung cancer. M yeloablative schemes included BEAM exclusively for lymphomas, busulfan and melphalan (Bu-MPH) mainly for myeloma, busulfan and cyclophosphamide (Bu-CT X) for lymphomas and leukemia and VP-16 and CTX for lung cancer. Mobilizati on of CD34(+) cells was achieved in all patients with the combination of hi gh-dose CTX and G-CSF with collections between 2.83 to 19.04 x 10(6)/kg (me an 7.1). All patients engrafted with a median time for recovery of PMN (>0. 5 x 10(3)/mu l) of 10 days (range 8-12 days) and for PLT (>20 x 10(3)/mu l) of 12 days (range 10-17 days). Major responses were obtained in 15 of 16 p atients evaluable for response and eight patients entered CR; overall eight patients are in CR, five are alive with disease, five are dead from diseas e progression and one is dead because of congestive heart failure 7 months following PBSC autotransplant. No early deaths following the procedure occu rred; major side-effects mere grade I-II mucositis (58%), fever with docume nted sepsis (10%), pneumonia (5%), cardiac, renal and liver toxicity (5%), Cardiac function was evaluated before and after myeloablative therapy by VE F in all patients; no significant modifications were necessary, In conclusi on, our experience demonstrates that myeloablative therapies in older selec ted patients can be feasible; the feasibility of introducing PBSC autotrans plantation following myeloablative therapy as a front-line treatment in pat ients aged >60 years, needs accurate guide lines for selection of appropria te patients.