Toxicities of high-dose chemotherapy and autologous hematopoietic cell transplantation in older patients with lymphoma

High-dose chemotherapy and autologous hematopoietic cell transplantation is an effective consolidation therapy in lymphoma; however, its use in elderly patients has been limited because of concerns for greater toxicity in this group. We investigated the toxicities of carmustine, etoposide, cytarabine, and melphalan (BEAM) and autologous hematopoietic cell transplantation (AHCT) in 346 patients in 2 age groups: 279 patients aged 60 to 69 years and 67 patients aged >= 70 years. The majority developed severe toxicities; the most common were febrile neutropenia, gastrointestinal, infections, and cardiovascular. Older patients were at higher risk for grade >= 3 cardiovascular toxicities (hazard ratio [HR], 3.36; 95% confidence interval [CI], 2.25-5.00; P < .001) and skin toxicities (HR, 2.45; 95% CI, 1.08-5.54, P = .032). In the older group, nonrelapse mortality at 100 days and at 2 years was 2.99% (95% CI, 0.55-9.32) and 6.2% (95% CI, 1.97-13.95), respectively, vs 1.79% (95% CI, 0.68-3.92) and 2.91% (95% CI, 1.37-5.42), respectively, in the younger group. When adjusting for the number of grade >= 3 toxicities within the first 100 days, older patients had a 1.71-fold (95% CI, 1.08-2.71) increased risk for progression or death relative to younger patients. Although BEAM followed by AHCT is effective, it is associated with significant organ toxicities, especially in patients aged >= 70 years. Interventions to mitigate toxicities while maintaining efficacy are much needed.

Automated summary

High-dose chemotherapy followed by autologous hematopoietic cell transplantation (AHCT) in lymphoma patients has been found to be effective, but older patients, especially those aged 70 and above, are at a higher risk of developing severe toxicities, including cardiovascular and skin toxicities. Nonrelapse mortality rates were higher in older patients compared to younger ones, and older patients had an increased risk of progression or death within the first 100 days post-treatment. Further interventions are needed to minimize toxicities while maintaining treatment efficacy.