UP-FRONT AUTOLOGOUS STEM CELL TRANSPLANTATION FOR ELDERLY PATIENTS WITH DIFFUSE LARGE B-CELL LYMPHOMA

Introduction: Recent increase of elderly patients with hematological malignancies should be noted. Among those, diffuse large B-cell lymphoma (DLBL) is most frequent. While the significance of autologous stem cell transplantation (ASCT) for chemotherapy-sensitive relapse of aggressive lymphoma has been established, survival effect of up-front ASCT is still controversial. We retrospectively analyzed the results of up-front ASCT for elderly patients with DLBL.Patients and methods: Thirty-three patients of 65-year-old or older (range 65-74, median 68) who received up-front ASCT were analyzed. They consisted of 17 males and 16 females. All of them were classified as high or high-intermediate risk group according to the International Prognostic Index. After induction of remission with CHOP, stem cells were mobilized by high-dose etoposide. Conditioning regimen consisted of ranimustine, cyclophosphamide, etoposide, and carboplatin. Rituximab was applied in 11 patients. Patients with insufficient stem cells, poor performance status, severe organ damage, or rejection of ASCT were excluded. Survival time was calculated from the day of ASCT and estimated by Kaplan-Meier method. Log-rank test was used to compare the results with those of 68 patients younger than 65 year-old.Results: No significant difference was seen in overall or event free survival rate between the two groups with observation periods of 2 to 171 months (56.3% vs 61.7%, 61.0% vs 51.7%, respectively). Use of rituximab did not affect the survival. Febrile neutropenia was major regimen related toxicity and no therapy related death was observed.Discussion: Up-front ASCT benefits selected elderly patients with high risk DLBL and the toxicity appears to be acceptable. Feasible indication should be investigated. Introduction: Recent increase of elderly patients with hematological malignancies should be noted. Among those, diffuse large B-cell lymphoma (DLBL) is most frequent. While the significance of autologous stem cell transplantation (ASCT) for chemotherapy-sensitive relapse of aggressive lymphoma has been established, survival effect of up-front ASCT is still controversial. We retrospectively analyzed the results of up-front ASCT for elderly patients with DLBL. Patients and methods: Thirty-three patients of 65-year-old or older (range 65-74, median 68) who received up-front ASCT were analyzed. They consisted of 17 males and 16 females. All of them were classified as high or high-intermediate risk group according to the International Prognostic Index. After induction of remission with CHOP, stem cells were mobilized by high-dose etoposide. Conditioning regimen consisted of ranimustine, cyclophosphamide, etoposide, and carboplatin. Rituximab was applied in 11 patients. Patients with insufficient stem cells, poor performance status, severe organ damage, or rejection of ASCT were excluded. Survival time was calculated from the day of ASCT and estimated by Kaplan-Meier method. Log-rank test was used to compare the results with those of 68 patients younger than 65 year-old. Results: No significant difference was seen in overall or event free survival rate between the two groups with observation periods of 2 to 171 months (56.3% vs 61.7%, 61.0% vs 51.7%, respectively). Use of rituximab did not affect the survival. Febrile neutropenia was major regimen related toxicity and no therapy related death was observed. Discussion: Up-front ASCT benefits selected elderly patients with high risk DLBL and the toxicity appears to be acceptable. Feasible indication should be investigated.