Retrospective single center analysis of toxicity and efficacy in high-dose chemotherapy (BEAM) and autologous stem cell transplantation in elderly patients (> 60 years) with relapsed lymphoma

High-dose chemotherapy followed by autologous haematopoietic stem cell transplantation (ASCT) is standard therapy for relapsed or primary refractory aggressive Non-Hodgkin lymphoma (NHL). Although the incidence of aggressive lymphoma with high risk features increases with age, the applicability of high-dose chemotherapy in patients aged > 60 is an issue due to concerns on toxicity and co-morbidity. We here present a retrospective single centre experience with high-dose chemotherapy using the BEAM preparative regiment followed by autologous HSC transplantation in elderly patients with relapsed lymphoma. Between 3/1994 and 6/2006, 79 consecutive patients received BEAM and ASCT in our institution. Of those, 20 patients were older than 60 years (range 60 to 69 years), and 59 patients younger than 60 years at commencement of therapy. A second control group of 10 patients younger than 60 years received TBI/Cy. Comparing hematopoietic recovery in theses age groups, the median days of neutropenia and thrombocytopenia in younger vs. elderly were 7.5 vs. 7 days, and 4 vs. 3.5 days, respectively. The necessity for erythrocyte transfusions was, however, significantly higher in elderly patients (43% WHO grad III/IV toxicity in younger vs. 70% in elderly patients). As for non-hematological toxicity, the incidences of severe infections and stomatitis, as well as diarrhoea and dysarrhythmias were higher in the elderly patients. All further parameters of non-hematological toxicity including treatment related mortality were equally distributed. In conclusion, high-dose chemotherapy with BEAM and ASCT is a feasible option for selected patients older 60 years. Algorithms to guide therapeutic decisions in elderly patients with relapsed aggressive lymphoma are to be developed.2014-01-2