Abstract
Recent developments in supportive care increase the number of elderly patients available for high dose therapy (HDT) supported by autologous PBSCT. In several clinical trials high dose chemotherapy supported by PBSCT as a part of first-line treatment in young NHL patients with poor prognostic features suggested survival benefit. It is not clear if the same strategy is applicable into the older patients. The Institute Paoli-Calmettes database was reviewed for all DLBCL patients received BEAM followed by PBSCT in two age cohorts: 50–59 years old and >=60 years old between January 1998 and December 2006 (9 years). All patients were HIV-negative and received BEAM intensification as a part of front-line treatment. All of them were grafted in situation of complete or partial response after CHOP or R-CHOP induction. There was no significant difference into the aaIPI score between the groups (aaIPI score ≥ 2: 17 pts (63%) in elderly and 17 pts (61%) in younger group. Factors evaluated included treatment-related mortality (TRM), overall survival (OS) and event-free survival (EFS). Fifty five patients were identified, among them 27 into the older cohort (median age 63 y, range 60–68) and 28 patients into the younger cohort (median age 55 y, range 51–59). The median follow-up for the whole group was 23,5 months (0,5–93 months). TRM into the older group (1/27 pts (3,7%)) was not statistically different from the younger patients (0/28 pts) and was comparable with previously published data. The estimated 5-year OS (figure 1) was 75,5% (95%CI 52–90%) for the older group (curve 1) compared to 85% (95%CI 63–95%) in the younger group (p=0,47) (curve 2). There were 8 events (1 TRM and 7 relapses) in the older group and 3 events (all relapses) in the younger group (3-year EFS (figure 2) 66% (curve 1) vs 85,5% (curve 2), p=0,16 and 5-year EFS 49,4% vs 85,5%, p=0.051). We conclude that front-line autologous PBSCT with BEAM conditioning can be safely performed in patients 60 years old and older with DLBCL after CHOP of R-CHOP induction. The toxicity profile and TRM may not be different from that of younger patients. The high rate of OS in older group is encouraging, but the relapse still remains the important obstacle for durable remission.
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