Cardiovascular toxicity is increased, but manageable, during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for patients aged 60 years and older

Abstract

High-dose therapy (HDT) for non-Hodgkins lymphoma (NHL) and multiple myeloma (MM) is considered a feasible option for patients aged ⩾60 years. This study compared the outcomes for all patients aged ⩾60 years treated with HDT at the center to a matched cohort group aged <60 years. Results for patients who were ⩾60 years at HDT between 1997 – 2002 were retrospectively analysed to assess efficacy and safety. Event-free (EFS) and overall survival (OS) rates were compared with a cohort group, matched by disease type, chemotherapy sensitivity, year of treatment and conditioning regimen. Patients with NHL were also matched by International Prognostic Index score. Forty patients aged ⩾60 years were identified. Median age was 65 (range 60 – 76) with 22 MM and 18 NHL; 50% had 1 or more co-morbidity; 35% had cardiovascular co-morbidity vs. 18% of controls (p = 0.075). Response rates (RR) following HDT for MM were: 4 (18%) complete responses (CR) and 18 (82%) partial responses (PR), giving an overall response rate (ORR) of 100%, vs. 77% for controls (p = 0.02). For NHL patients there were: 8 CR (44%) and 4 PR (22%), giving an ORR of 67%, vs. 83% for controls (p = 0.3). Transplant-related mortality was 8% compared to 5% in controls (p = 0.6). Toxicities were similar with the exception of cardiac toxicity, which was significantly higher in patients aged ⩾60 years vs. controls (50% ⩾grade 3 vs. 10%: p < 0.0001). Atrial fibrillation was the most frequent cardiovascular toxicity (9 patients). At a median follow-up of 33 months, there is no significant difference between older vs. younger patients in median EFS (24 vs. 38 months: p = 0.78) or OS (40 months vs. not reached: p = 0.23). HDT is feasible and effective in selected patients ⩾60 years with MM and NHL. Patients ⩾60 years are more susceptible to cardiovascular toxicities, particularly atrial fibrillation, but have similar or better response rates following HDT and similar long-term outcomes to younger patients.

Keywords:

• Elderly
• multiple myeloma
• non-Hodgkins lymphoma
• high-dose therapy
• transplantation