TY - JOUR
T1 - Outcomes of Autologous Hematopoietic Cell Transplantation in Older Patients with Diffuse Large B-Cell Lymphoma
AU - Munshi, Pashna N.
AU - Chen, Yue
AU - Ahn, Kwang W.
AU - Awan, Farrukh T.
AU - Cashen, Amanda
AU - Shouse, Geoffrey
AU - Shadman, Mazyar
AU - Shaughnessy, Paul
AU - Zurko, Joanna
AU - Locke, Frederick L.
AU - Goodman, Aaron M.
AU - Bisneto, Jose C.Villaboas
AU - Sauter, Craig
AU - Kharfan-Dabaja, Mohamad A.
AU - Meyers, Gabrielle
AU - Jaglowski, Samantha
AU - Herrera, Alex
AU - Hamadani, Mehdi
N1 - Funding Information:
Conflict of interest statement: P.M. reports Consultancy for Incyte Corporation; Speaker's Bureau for Incyte Corporation and Kite. M.H. reports Consultancy for Incyte Corporation, ADC Therapeutics, Pharmacyclics, Omeros, Verastem, Genmab, Morphosys, Kite, Novartis, Kadmon; and Speaker's Bureau for Sanofi Genzyme, AstraZeneca, BeiGene, and ADC Therapeutics. P.S. reports Speakers Bureau for Sanofi Genzyme, Kite, and BMS; Advisory Board for Sanofi Genzyme and Novartis. M.S. reports Consulting, Advisory Boards, steering committees, or data safety monitoring committees for Abbvie, Genentech, AstraZeneca, Sound Biologics, Pharmacyclics, Beigene, Bristol Myers Squibb, Morphosys/Incyte, TG Therapeutics, Innate Pharma, Kite Pharma, Adaptive Biotechnologies, Epizyme, Eli Lilly, Adaptimmune, Mustang Bio, Regeneron, Merck and Atara Biotherapeutics; research funding for Mustang Bio, Celgene, Bristol Myers Squibb, Pharmacyclics, Gilead, Genentech, AbbVie, TG Therapeutics, Beigene, AstraZeneca, Sunesis, Atara Biotherapeutics, and Genmab. F.L. reports Consulting or advisory role with ecoR1, Emerging Therapy Solutions Gerson Lehman Group, Allogene, Amgen, Bluebird Bio, BMS/Celgene, Calibr, Iovance, Kite, a Gilead Company, Janssen, Legend Biotech, Novartis, Umoja, Cowen, Cellular Biomedicine Group, GammaDelta Therapeutics, and Wugen; research funding from Kite, a Gilead Company, Allogene and Novartis; and patents, royalties, other intellectual property from several patents held by the institution in his name (unlicensed) in the field of cellular immunotherapy. A.G. reports Consulting for Seattle Genetics and EUSA Pharma. G.S. reports Speaker's Bureau for Kite and Honorarium for Beigene. F.T.A. reports Consultancy for Genentech, Astrazeneca, Abbvie, Janssen, Pharmacyclics, Gilead Sciences, Kite Pharma, Celgene, Karyopharm, MEI Pharma, Verastem, Incyte, Beigene, Johnson and Johnson, Dava Oncology, BMS, Merck, Cardinal Health, ADCT Therapeutics, and Epizyme. C.S. reports Consultancy on advisory boards for Juno Therapeutics, Sanofi-Genzyme, Spectrum Pharmaceuticals, Novartis, Genmab, Precision Biosciences, Kite/a Gilead Company, Celgene/BMS, Gamida Cell, Karyopharm Therapeutics, and GSK; research funds from Juno Therapeutics, Celgene/BMS, Bristol-Myers Squibb, Precision Biosciences, and Sanofi-Genzyme. S.J. reports Advisory Boards for Kite Therapeutics, Novartis, Juno/BMS, Takeda Inc, and CRISPR Therapeutics; research funding from Kite Therapeutics and Novartis. A.H. reports Consultancy for BMS, Genentech, Merck, AstraZeneca, Karyopharm, ADC Therapeutics, Takeda, Tubulis, Regeneron, and Genmab; and research funding from BMS, Genentech, Merck, Seattle Genetics, Kite, Gilead Sciences, AstraZeneca, and ADC Therapeutics.
Funding Information:
Financial disclosure: Supported by CIBMTR.
Funding Information:
Financial disclosure: Supported by CIBMTR. Conflict of interest statement: P.M. reports Consultancy for Incyte Corporation; Speaker's Bureau for Incyte Corporation and Kite. M.H. reports Consultancy for Incyte Corporation, ADC Therapeutics, Pharmacyclics, Omeros, Verastem, Genmab, Morphosys, Kite, Novartis, Kadmon; and Speaker's Bureau for Sanofi Genzyme, AstraZeneca, BeiGene, and ADC Therapeutics. P.S. reports Speakers Bureau for Sanofi Genzyme, Kite, and BMS; Advisory Board for Sanofi Genzyme and Novartis. M.S. reports Consulting, Advisory Boards, steering committees, or data safety monitoring committees for Abbvie, Genentech, AstraZeneca, Sound Biologics, Pharmacyclics, Beigene, Bristol Myers Squibb, Morphosys/Incyte, TG Therapeutics, Innate Pharma, Kite Pharma, Adaptive Biotechnologies, Epizyme, Eli Lilly, Adaptimmune, Mustang Bio, Regeneron, Merck and Atara Biotherapeutics; research funding for Mustang Bio, Celgene, Bristol Myers Squibb, Pharmacyclics, Gilead, Genentech, AbbVie, TG Therapeutics, Beigene, AstraZeneca, Sunesis, Atara Biotherapeutics, and Genmab. F.L. reports Consulting or advisory role with ecoR1, Emerging Therapy Solutions Gerson Lehman Group, Allogene, Amgen, Bluebird Bio, BMS/Celgene, Calibr, Iovance, Kite, a Gilead Company, Janssen, Legend Biotech, Novartis, Umoja, Cowen, Cellular Biomedicine Group, GammaDelta Therapeutics, and Wugen; research funding from Kite, a Gilead Company, Allogene and Novartis; and patents, royalties, other intellectual property from several patents held by the institution in his name (unlicensed) in the field of cellular immunotherapy. A.G. reports Consulting for Seattle Genetics and EUSA Pharma. G.S. reports Speaker's Bureau for Kite and Honorarium for Beigene. F.T.A. reports Consultancy for Genentech, Astrazeneca, Abbvie, Janssen, Pharmacyclics, Gilead Sciences, Kite Pharma, Celgene, Karyopharm, MEI Pharma, Verastem, Incyte, Beigene, Johnson and Johnson, Dava Oncology, BMS, Merck, Cardinal Health, ADCT Therapeutics, and Epizyme. C.S. reports Consultancy on advisory boards for Juno Therapeutics, Sanofi-Genzyme, Spectrum Pharmaceuticals, Novartis, Genmab, Precision Biosciences, Kite/a Gilead Company, Celgene/BMS, Gamida Cell, Karyopharm Therapeutics, and GSK; research funds from Juno Therapeutics, Celgene/BMS, Bristol-Myers Squibb, Precision Biosciences, and Sanofi-Genzyme. S.J. reports Advisory Boards for Kite Therapeutics, Novartis, Juno/BMS, Takeda Inc, and CRISPR Therapeutics; research funding from Kite Therapeutics and Novartis. A.H. reports Consultancy for BMS, Genentech, Merck, AstraZeneca, Karyopharm, ADC Therapeutics, Takeda, Tubulis, Regeneron, and Genmab; and research funding from BMS, Genentech, Merck, Seattle Genetics, Kite, Gilead Sciences, AstraZeneca, and ADC Therapeutics. Authorship statement: P.N.M. and M.H. designed the study. Y.C. and M.H. collected and assembled the data. Y.C. M.H. and K.W.A. analyzed the data. P.N.M. Y.C. K.W.A. F.T.A. A.C. G.S. M.S. P.S. J.Z. F.L.L. A.M.G. J.C.V.B. C.S. M.A.K-D. G.M. S.J. and A.H. interpreted the data. P.N.M. and M.H. wrote the first draft. P.N.M. Y.C. K.W.A. F.T.A. A.C. G.S. M.S. P.S. J.Z. F.L.L. A.M.G. J.C.V.B. C.S. M.A.K-D. G.M. S.J. and A.H. revised the manuscript. Financial disclosure: See Acknowledgments on page XXXX.
Publisher Copyright:
© 2022 The American Society for Transplantation and Cellular Therapy
PY - 2022
Y1 - 2022
N2 - Data for outcomes after autologous hematopoietic cell transplantation (auto-HCT) in diffuse large B-cell lymphoma (DLBCL) patients ≥70 years are limited. Auto-HCT is feasible in older DLBCL patients. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes of auto-HCT in DLBCL patients aged 60 to 69 years (n = 363) versus ≥70 years (n = 103) between 2008 and 2019. Non-relapse mortality (NRM), relapse/progression (REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models. All patients received BEAM conditioning (carmustine, etoposide, cytosine arabinoside and melphalan). On univariate analysis, in the 60 to 69 years versus ≥70 years cohorts, 100-day NRM was 3% versus 4%, 5-year REL was 47% versus 45%, 5-year PFS 40% versus 38% and 5-year OS 55% versus 41%, respectively. On multivariate analysis, patients ≥70 had no significant difference in NRM (hazard ratio [HR] 1.43, 95% confidence interval [CI] 0.85-2.39), REL (HR 1.11, 95% CI 0.79-1.56), PFS (HR 1.23, 95% CI 0.92-1.63) compared to patients 60 to 69 years. Patients ≥70 years had a higher mortality (HR 1.39, 95% CI 1.05-1.85, p=0.02), likely because of inferior post-relapse OS in this cohort (HR 1.82, 95% CI 1.27-2.61, P = .001). DLBCL was the major cause of death in both cohorts (62% versus 59%). Older patients should not be denied auto-HCT solely on the basis of chronological age.
AB - Data for outcomes after autologous hematopoietic cell transplantation (auto-HCT) in diffuse large B-cell lymphoma (DLBCL) patients ≥70 years are limited. Auto-HCT is feasible in older DLBCL patients. Using the Center for International Blood and Marrow Transplant Research database, we compared outcomes of auto-HCT in DLBCL patients aged 60 to 69 years (n = 363) versus ≥70 years (n = 103) between 2008 and 2019. Non-relapse mortality (NRM), relapse/progression (REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models. All patients received BEAM conditioning (carmustine, etoposide, cytosine arabinoside and melphalan). On univariate analysis, in the 60 to 69 years versus ≥70 years cohorts, 100-day NRM was 3% versus 4%, 5-year REL was 47% versus 45%, 5-year PFS 40% versus 38% and 5-year OS 55% versus 41%, respectively. On multivariate analysis, patients ≥70 had no significant difference in NRM (hazard ratio [HR] 1.43, 95% confidence interval [CI] 0.85-2.39), REL (HR 1.11, 95% CI 0.79-1.56), PFS (HR 1.23, 95% CI 0.92-1.63) compared to patients 60 to 69 years. Patients ≥70 years had a higher mortality (HR 1.39, 95% CI 1.05-1.85, p=0.02), likely because of inferior post-relapse OS in this cohort (HR 1.82, 95% CI 1.27-2.61, P = .001). DLBCL was the major cause of death in both cohorts (62% versus 59%). Older patients should not be denied auto-HCT solely on the basis of chronological age.
KW - Autologous transplant
KW - BEAM
KW - Diffuse large B cell lymphoma
KW - Older
KW - Relapse
UR - http://www.scopus.com/inward/record.url?scp=85132887608&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85132887608&partnerID=8YFLogxK
U2 - 10.1016/j.jtct.2022.05.029
DO - 10.1016/j.jtct.2022.05.029
M3 - Article
C2 - 35609865
AN - SCOPUS:85132887608
SN - 2666-6375
JO - Transplantation and Cellular Therapy
JF - Transplantation and Cellular Therapy
ER -