Efficacy of high-dose therapy and autologous hematopoietic stem cell transplantation for non-Hodgkin's lymphoma in adults 60 years of age and older

High-dose therapy (NDT) with autologous stem cell transplantation (ASCT) is the optimal treatment for patients with relapsed aggressive non-Hodgkin's lymphoma (NHL), HDT, however, is often reserved for relatively younger pati ents due to limited data in older adults. We treated 53 patients aged 60 ye ars and older (median age 62 years, range 60.3-67.7 years) with HDT and ASC T for NHL at our centers. Forty-four patients (83%) had aggressive histolog y, 75% had chemosensitive disease and all had failed anthracycline therapy. Conditioning regimens included busulfan, melphalan, and thiotepa (45%); cy clophosphamide (CY), etoposide (VP-16), and total body irradiation (TBI) (3 0%); CY and TBI (15%); and other regimens (10%). Estimated 4-year overall s urvival (OS), progression-free survival, and treatment-related mortality (T RM) were 33%, 24% and 22%, respectively. A multivariable analysis demonstra ted that patients with chemosensitive disease (P = 0.03) and less than or e qual to3 prior regimens (P = 0.03) had superior survival. Four-year OS in p atients with chemosensitive disease was 39% vs 15% in patients with chemore sistant disease. Reduced TRM was associated with the CY, VP-16 and TBI regi men (P = 0.02), HDT therapy with ASCT may result in prolonged survival and potential cure for about a quarter of elderly patients, and for almost 40% with chemosensitive disease. Optimal conditioning regimen selection may fur ther improve outcome by reducing TRM, Age alone should not be used to exclu de patients from receiving myeloablative therapy with ASCT.