High Dose Therapy (HDCT) with Autologous Stem Cell Transplantation (ASCT) for Non-Hodgkin Lymphoma in the Elderly: Feasibility of a Patient-Tailored Treatment Plan.

HDCT followed by peripheral stem cell (PBSC) rescue is a suitable and effective option for patients (pts) affected by aggressive non-Hodgkin’s lymphoma (NHL) with chemosensitive disease at first relapse. Elderly pts are usually excluded from HDCT programs because of low stem cell collections and low tolerance to intensive chemotherapy. The Comprehensive Geriatric Scale (CGA) is a multidimensional pt evaluation that leads to the identification the therapeutic options. We designed a CGA-driven approach for elderly pts (between 60 and 75 years) affected by aggressive NHL in first relapse. Between October 23, 2000 and August 4, 2003 9 pts with NHL, 60 years of age and older were evaluated for ASCT at the Division of Medical Oncology A, National Cancer Institute, Aviano. Pts are stratified in 3 groups: 1) “frail pts” who do not undergo a HDCT program; 2) pts “at standard risk”, who scored 6 and 8 in the Activity of Daily Living (ADL) and Instrumental Activity of Daily Living (IADL) evaluation, respectively, with a Geriatric Depression Scale (GDS) score <11 and a Mini Mental Status (MMS) score >21 with a good respiratory function and no grade 2 comorbidities, who undergo a HDCT program with BEAM as conditioning regimen; 3) pts at “intermediate risk” who scored at least 5 and 7 in the ADL and IADL evaluation, respectively, with a GDS score <11 and a MMS score >21 and a score of no more than 2 in 1 to 3 comorbidities, who undergo a less aggressive HDCT program with double Melphalan 200 mg/m² as conditioning regimen. Out of 9 pts 4 underwent to ASCT. The Data are summarized in table 1. CGA has emerged as a mandatory evaluation to guide therapeutic options and establish the prognosis of elderly patients. Stratification of patients into different prognostic groups according to a CGA can render HDCT a feasible and, possibly, effective procedure also in selected elderly patients affected by aggressive NHL.

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