Contributions
Abstract: PB2463
Type: Publication Only
Background
Autologous hematopoietic cell transplant (auto-HCT) remains a cornerstone consolidation strategy in the front line treatment of Multiple Myeloma (MM) and Lymphomas in young and fit patients. However, with the better toxicity profile of new drugs used in induction phase and in conditioning, as well as the improvement in their management, auto-HCT is more often considered in older patients.
Aims
The aim of this retrospective study was to assess the feasibility and efficacy of consolidation auto-HCT for lymphoid malignancies in patients of 65 years old and beyond.
Methods
Between years 2012 and 2016, 54 patients aged 65 years and beyond, received auto-HCT, median age at transplantation was 67 years (range: 65-71), 23 (43%) were female. Diagnosis was MM in 45 (83%) patients and lymphoma in 9 (17%) patients (2 Diffuse B Cell, 4 mantle cell, 1 follicular, 1 Hodgkin and 1 T cell). Performance status (PS) at transplantation was 0 in 16% of patients, 1 in 78% and 2 in 6%. Auto-HCT was used in first line strategy for the majority of patients (N=45, 83%). For the multiple myeloma patients, the induction treatment was mostly bortezomib-based regimen [VTD (56%), VCD (15%), VRD (5%), VD (5%)] and 5% received lenalidomide and dexamethasone. The lymphoma patients received RDHAP (6 patients), DHAP (1), Brentuximab (1), RCHOP (1).
The majority of patients were easily collected for HC without the need of mobilization with plerixafor (78%), the median number of CD34 collected cells was 3.99 million/kg (range 2.04 to 10.96). One MM patient received a tandem auto-HCT.
Disease response at transplantation was as follow: in MM patients, 9 (20%) CR, 14 (30%) VGPR, 20 PR and 2 less than PR; in lymphoma patients, 5 (56%) were in complete radiological response and 4 (44%) were in PR.
MM patients received Melphalan-based conditioning, 24 (53%) received the standard dose of 200 mg/m2, 12 (27%) received 140 mg/m2 and 9 (20%) received 100 mg/m2. The lymphoma patients were conditioned with either BEAM (N=6), RBEAM (N=2) or TEAM (N=1).
Results
After transplantation, the median time to neutrophils recovery (neutrophils > 0.5 x 109/L) was 11 days (range: 9-20) and the median time to platelets recovery (platelet > 50 x 109/) was 15 days (range: 10-29). The median duration of hospitalization after transplantation was 17 days (range: 9-28), at hospital discharge 28 (53%) patients had a PS of 1. Main toxicities were gastro-intestinal and febrile neutropenia, 34 (63%) patients had mucitis, of those, 23 (68%) grade 1-2 and 10 (%) grade 3-4. Forty patients had nausea and vomiting, 21 (52%) were of grade 3-4; 37 patients had diarrhea, 22 (60%) were grade 1-2. Febrile neutropenia was observed in most patients (N=45, 82%). After a median follow up of 32 months, the median progression-free survival rate was 22 months and median overall survival was not reached. At the last follow-up, 45 patients were alive, 9 patients died, all of them had progressive disease (6 were MM), 2 died of septic shock after a chemotherapy treatment.
Conclusion
We showed that auto-HCT is a feasible and well tolerated treatment option for patient with lymphoid malignancies with 65 years old and beyond, no death related to this procedure, this was mainly due to the good patient selection and the better prevention and management of the procedure-related toxicities and complications.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous bone marrow transplant, Elderly
Abstract: PB2463
Type: Publication Only
Background
Autologous hematopoietic cell transplant (auto-HCT) remains a cornerstone consolidation strategy in the front line treatment of Multiple Myeloma (MM) and Lymphomas in young and fit patients. However, with the better toxicity profile of new drugs used in induction phase and in conditioning, as well as the improvement in their management, auto-HCT is more often considered in older patients.
Aims
The aim of this retrospective study was to assess the feasibility and efficacy of consolidation auto-HCT for lymphoid malignancies in patients of 65 years old and beyond.
Methods
Between years 2012 and 2016, 54 patients aged 65 years and beyond, received auto-HCT, median age at transplantation was 67 years (range: 65-71), 23 (43%) were female. Diagnosis was MM in 45 (83%) patients and lymphoma in 9 (17%) patients (2 Diffuse B Cell, 4 mantle cell, 1 follicular, 1 Hodgkin and 1 T cell). Performance status (PS) at transplantation was 0 in 16% of patients, 1 in 78% and 2 in 6%. Auto-HCT was used in first line strategy for the majority of patients (N=45, 83%). For the multiple myeloma patients, the induction treatment was mostly bortezomib-based regimen [VTD (56%), VCD (15%), VRD (5%), VD (5%)] and 5% received lenalidomide and dexamethasone. The lymphoma patients received RDHAP (6 patients), DHAP (1), Brentuximab (1), RCHOP (1).
The majority of patients were easily collected for HC without the need of mobilization with plerixafor (78%), the median number of CD34 collected cells was 3.99 million/kg (range 2.04 to 10.96). One MM patient received a tandem auto-HCT.
Disease response at transplantation was as follow: in MM patients, 9 (20%) CR, 14 (30%) VGPR, 20 PR and 2 less than PR; in lymphoma patients, 5 (56%) were in complete radiological response and 4 (44%) were in PR.
MM patients received Melphalan-based conditioning, 24 (53%) received the standard dose of 200 mg/m2, 12 (27%) received 140 mg/m2 and 9 (20%) received 100 mg/m2. The lymphoma patients were conditioned with either BEAM (N=6), RBEAM (N=2) or TEAM (N=1).
Results
After transplantation, the median time to neutrophils recovery (neutrophils > 0.5 x 109/L) was 11 days (range: 9-20) and the median time to platelets recovery (platelet > 50 x 109/) was 15 days (range: 10-29). The median duration of hospitalization after transplantation was 17 days (range: 9-28), at hospital discharge 28 (53%) patients had a PS of 1. Main toxicities were gastro-intestinal and febrile neutropenia, 34 (63%) patients had mucitis, of those, 23 (68%) grade 1-2 and 10 (%) grade 3-4. Forty patients had nausea and vomiting, 21 (52%) were of grade 3-4; 37 patients had diarrhea, 22 (60%) were grade 1-2. Febrile neutropenia was observed in most patients (N=45, 82%). After a median follow up of 32 months, the median progression-free survival rate was 22 months and median overall survival was not reached. At the last follow-up, 45 patients were alive, 9 patients died, all of them had progressive disease (6 were MM), 2 died of septic shock after a chemotherapy treatment.
Conclusion
We showed that auto-HCT is a feasible and well tolerated treatment option for patient with lymphoid malignancies with 65 years old and beyond, no death related to this procedure, this was mainly due to the good patient selection and the better prevention and management of the procedure-related toxicities and complications.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): Autologous bone marrow transplant, Elderly