The Impact of Advanced Patient Age on Mortality after Allogeneic Hematopoietic Cell Transplantation for Non-Hodgkin Lymphoma: A Retrospective Study by the European Society for Blood and Marrow Transplantation Lymphoma Working Party

Abstract

More than 60% of patients with non-Hodgkin lymphoma (NHL) are age>60 years at presentation. The purpose of thisstudy was to compare the potential risks and benefits of allogeneic hematopoietic cell transplantation (alloHCT) inelderly patients with NHL with younger patients in a large sample, also taking into account comorbidity information. Allpatients age 18 years who had undergone alloHCT from a matched sibling or unrelated donor for NHL between 2003and 2013 and were registered with the European Society forBlood and Marrow Transplantation were eligible for thestudy. The primary study endpoint was 1-year nonrelapse mortality (NRM). A total of 3919 patients were eligible andwere categorized by age: young (Y), 18 to 50 y (n = 1772); middle age (MA), 51 to 65 y (n = 1967); or old (O), 66 to 77 y(n = 180). Follicular lymphoma was present in 37% of the patients; diffuse large B cell lymphoma, in 30%; mantle cell lym-phoma, in 21%, and peripheral T cell lymphoma, in 11%. At thetime of alloHCT, 85% of the patients were chemosensitiveand 15% were chemorefractory. With a median follow-upof 4.5 years in survivors, NRM at 1 year was 13% for theY group. 20% for the MA group, and 33% for the O group (P<.001), whereas relapse incidence and overall survival (OS)at 3 years in the 3 groups were 30%, 31%, and 28% (P= .355) and 60%, 54%, and 38% (P<.001), respectively. Multivariableadjustment for confounders, including sex, NHL subset, time from diagnosis, chemosensitivity, donor, and conditioning,confirmed older age as a significant predictor for NRM and OS, but not for relapse risk. Although comorbidity was a sig-nificant predictor of NRM in a subset analysis restricted to the979 patients with comorbidity information available, ageretained its significant impact on NRM. In conclusion, our data show that alloHCT in patients age>65 y provides similarNHL control as seen in younger patients but is associated with a higher NRM that is not fully explained by comorbidity.Thus, although alloHCT is feasible and effective in very oldpatients, the increased NRM risk must be taken into accountwhen assessing the indication for alloHCT for NHL in this age group.