@article{360fdb7e2fdf4124aee2d21d044d05c2,
title = "Allotransplantation for Patients Age ≥40 Years with Non-Hodgkin Lymphoma: Encouraging Progression-Free Survival",
abstract = "Non-Hodgkin lymphoma (NHL) disproportionately affects older patients, who do not often undergo allogeneic hematopoietic cell transplantation (HCT). We analyzed Center for International Blood and Marrow Transplant Research data on 1248 patients age ≥40 years receiving reduced-intensity conditioning (RIC) or nonmyeloablative (NMA) conditioning HCT for aggressive (n = 668) or indolent (n = 580) NHL. Aggressive lymphoma was more frequent in the oldest cohort 49% for age 40 to 54 versus 57% for age 55 to 64 versus 67% for age ≥65; P =.0008). Fewer patients aged ≥65 had previous autografting (26% versus 24% versus 9%; P =.002). Rates of relapse, acute and chronic GVHD, and nonrelapse mortality (NRM) at 1 year post-HCT were similar in the 3 age cohorts (22% [95% confidence interval (CI), 19% to 26%] for age 40 to 54, 27% [95% CI, 23% to 31%] for age 55 to 64, and 34% [95% CI, 24% to 44%] for age ≥65. Progression-free survival (PFS) and overall survival (OS) at 3 years was slightly lower in the older cohorts (OS: 54% [95% CI, 50% to 58%] for age 40 to 54; 40% [95% CI, 36% to 44%] for age 55 to 64, and 39% [95% CI, 28% to 50%] for age ≥65; P <.0001). Multivariate analysis revealed no significant effect of age on the incidence of acute or chronic GVHD or relapse. Age ≥55 years, Karnofsky Performance Status <80, and HLA mismatch adversely affected NRM, PFS, and OS. Disease status at HCT, but not histological subtype, was associated with worse NRM, relapse, PFS, and OS. Even for patients age ≥55 years, OS still approached 40% at 3 years, suggesting that HCT affects long-term remission and remains underused in qualified older patients with NHL.",
keywords = "Allogeneic, Elderly, Hematopoietic cell transplantation, Lymphoma, Nonmyeloablative, Reduced intensity",
author = "McClune, {Brian L.} and Ahn, {Kwang Woo} and Wang, {Hai Lin} and Antin, {Joseph H.} and Artz, {Andrew S.} and Cahn, {Jean Yves} and Abhinav Deol and Freytes, {C{\'e}sar O.} and Mehdi Hamadani and Holmberg, {Leona A.} and Jagasia, {Madan H.} and Jakubowski, {Ann A.} and Kharfan-Dabaja, {Mohamed A.} and Lazarus, {Hillard M.} and Miller, {Alan M.} and Richard Olsson and Pedersen, {Tanya L.} and Joseph Pidala and Pulsipher, {Michael A.} and Rowe, {Jacob M.} and Wael Saber and {van Besien}, {Koen W.} and Waller, {Edmund K.} and Aljurf, {Mahmoud D.} and G{\"o}rgun Akpek and Ulrike Bacher and Chao, {Nelson J.} and Chen, {Yi Bin} and Cooper, {Brenda W.} and Jason Dehn and {de Lima}, {Marcos J.} and Hsu, {Jack W.} and Lewis, {Ian D.} and Marks, {David I.} and Joseph McGuirk and Cairo, {Mitchell S.} and Schouten, {Harry C.} and Jeffrey Szer and Muthalagu Ramanathan and Savani, {Bipin N.} and Matthew Seftel and G{\'e}rard Socie and Ravi Vij and Warlick, {Erica D.} and Weisdorf, {Daniel J.}",
note = "Funding Information: Financial disclosure: The Center for International Blood and Transplant Research is supported by Public Health Service Grant/Cooperative Agreement U24-CA76518 from the National Cancer Institute (NCI) , the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases ; Grant/Cooperative Agreement 5U01HL069294 from the NHLBI and NCI; Contract HHSH234200637015C with the Health Resources and Services Administration; Grants N00014-06-1-0704 and N00014-08-1-0058 from the Office of Naval Research; and grants from the American Association of Blood Banks, Aetna, American Society for Blood and Marrow Transplantation, Amgen, anonymous donation to the Medical College of Wisconsin, Association of Medical Microbiology and Infectious Disease Canada, Astellas Pharma US, Baxter International, Bayer HealthCare Pharmaceuticals, Blood Center of Wisconsin, Blue Cross and Blue Shield Association, Bone Marrow Foundation, Canadian Blood and Marrow Transplant Group, Celgene, CellGenix, Centers for Disease Control and Prevention, ClinImmune Labs, CTI Clinical Trial and Consulting Services, Cubist Pharmaceuticals, Cylex, CytoTherm, DOR BioPharma, Dynal Biotech, Enzon Pharmaceuticals, European Group for Blood and Marrow Transplantation, Gambro BCT, Gamida Cell, Genzyme, Histogenetics, HKS Medical Information Systems, Hospira, Infectious Diseases Society of America, Kiadis Pharma, Kirin Brewery, Merck & Company, Medical College of Wisconsin, MGI Pharma, Michigan Community Blood Centers, Millennium Pharmaceuticals, Miller Pharmacal Group, Milliman USA, Miltenyi Biotec, National Marrow Donor Program, Nature Publishing Group, New York Blood Center, Novartis Oncology, Oncology Nursing Society, Osiris Therapeutics, Otsuka Pharmaceutical Development & Commercialization, Pall Life Sciences, PDL BioPharma, Pfizer, Pharmion, Saladax Biomedical, Schering Plough, Society for Healthcare Epidemiology of America, StemCyte, StemSoft Software, Sysmex, Teva Pharmaceutical Industries, The Marrow Foundation, Therako, Vidacare, Vion Pharmaceuticals,ViraCor Laboratories, ViroPharma, and Wellpoint. The views expressed in this article do not reflect the official policy or position of the National Institute of Health, the Department of the Navy, the Department of Defense, or any other agency of the US Government. This project was supported in part by funding from the National Marrow Donor Program and Health Resources and Services Administration Contract HHSH234200637020C to the National Marrow Donor Program. The views expressed in this article do not reflect the official policy or position of the Health Resources and Services Administration or the National Marrow Donor Program. Copyright: Copyright 2014 Elsevier B.V., All rights reserved.",
year = "2014",
month = jul,
doi = "10.1016/j.bbmt.2014.03.013",
language = "English (US)",
volume = "20",
pages = "960--968",
journal = "Biology of Blood and Marrow Transplantation",
issn = "1083-8791",
publisher = "Elsevier Inc.",
number = "7",
}