Autologous blood and marrow transplantation in patients 60 years and older

Although many hematologic malignancies are more common in older patients, a utologous blood and marrow transplantation (ABMT) has traditionally been re stricted to patients younger than 60 years because of concerns that older p atients would be either unable to provide a graft or unable to tolerate the therapy. From June 1995 to May 1998, 30 patients greater than or equal to 60 years underwent ABMT at our institution for low-grade lymphoma (4 patien ts), relapsed intermediate-grade lymphoma (17 patients), or multiple myelom a (9 patients). The median patient age was 62.5 years (range 60-73). Pretra nsplantation conditioning regimens were CBV (cyclophosphamide, BCNU [carmus tine], etoposide) or BEAM (carmustine, etoposide, cytarabine, melphalan) fo r intermediate-grade lymphoma patients and melphalan 140 mg/m(2) + etoposid e 60 mg/kg + total body irradiation 500 cGy for the others. The rescue prod uct was bone marrow (BM; 4 patients), peripheral blood stem cells (PBSC; 23 patients), or BM+PBSC (3 patients). The median number of CD34(+) cells/kg infused was 3.60 x 10(6)(range 0.53-31.0), by the International Society for Hematotherapy and Graft Engineering method. The treatment-related mortalit y at day 100 and at 6 months was 10% and 16.7%, respectively. The median da ys to neutrophil >0.5 x 10(9)/L was 11 (range 9-25) and platelets >20 x 10( 9)/L was 16 (range 6-70). Three patients died of infection (days 26, 27, an d 38), and 1 died of an intracranial hemorrhage related to persistent throm bocytopenia (day 130). Bearman regimen-related toxicity was moderate, with most toxicities less than or equal to grade 2. Seven patients developed sig nificant gut toxicity: 4 patients with Clostridium difficile colitis and 3 patients with neutropenic enterocolitis. Depressive symptoms and signs were noted in 4 patients. Three male patients developed decreased gonadal funct ion after transplantation. These transplantations accounted for 997 patient days, of which 266 days (27%) were in the outpatient BMT program-a smaller percentage than in patients <60 years (56%, P = .002). Twenty patients are alive 153 to <greater than or equal to>1224 days after transplantation. AB MT in patients greater than or equal to 60 years of age is feasible. Furthe r studies addressing supportive care particular to older patients and compa risons of ABMT with traditional approaches to multiple myeloma and relapsed non-Hodgkin's lymphoma in older patients are needed. Further work to ident ify elderly patients most likely to benefit from this approach is also requ ired.