Faculty Collaboration Database

Outcomes of Medicare-age eligible NHL patients receiving RIC allogeneic transplantation: a CIBMTR analysis. Blood Adv 2018 Apr 24;2(8):933-940

Date

04/25/2018

Pubmed ID

29685953

Pubmed Central ID

PMC5916010

DOI

10.1182/bloodadvances.2018018531

Scopus ID

2-s2.0-85055419410 (requires institutional sign-in at Scopus site)   28 Citations

Abstract

The application of allogeneic hematopoietic cell transplantation (allo-HCT) in non-Hodgkin lymphoma (NHL) patients ≥65 years in the United States is limited by lack of Medicare coverage for this indication. Using the Center for International Blood and Marrow Transplant Research (CIBMTR) database, we report allo-HCT outcomes of NHL patients aged ≥65 years (older cohort; n = 446) compared with a cohort of younger NHL patients aged 55-64 years (n = 1183). We identified 1629 NHL patients undergoing a first reduced-intensity conditioning (RIC) or nonmyeloablative conditioning allo-HCT from 2008 to 2015 in the United States. Cord blood or haploidentical transplants were excluded. The median age was 68 years (range 65-77) for the older cohort vs 60 years (range 55-64) in the younger cohort. The 4-year adjusted probabilities of nonrelapse mortality (NRM), relapse/progression (R/P), progression-free survival (PFS), and overall survival (OS) of the younger and older groups were 24% vs 30% (P = .03), 41% vs 42% (P = .82), 37% vs 31% (P = .03), and 51% vs 46% (P = .07), respectively. Using multivariate analysis, compared with the younger group, the older cohort was associated with increased NRM, but there was no difference between the 2 cohorts in terms of R/P, PFS, or OS. The most common cause of death was disease relapse in both groups. In NHL patients eligible for allo-HCT, there was no difference in OS between the 2 cohorts. Age alone should not determine allo-HCT eligibility in NHL, and Medicare should expand allo-HCT coverage to older adults.

Author List

Shah NN, Ahn KW, Litovich C, Fenske TS, Ahmed S, Battiwalla M, Bejanyan N, Dahi PB, Bolaños-Meade J, Chen AI, Ciurea SO, Bachanova V, DeFilipp Z, Epperla N, Farhadfar N, Herrera AF, Haverkos BM, Holmberg L, Hossain NM, Kharfan-Dabaja MA, Kenkre VP, Lazarus HM, Murthy HS, Nishihori T, Rezvani AR, D'Souza A, Savani BN, Ulrickson ML, Waller EK, Sureda A, Smith SM, Hamadani M

Authors

Kwang Woo Ahn PhD Director, Professor in the Data Science Institute department at Medical College of Wisconsin
Anita D'Souza MD Professor in the Medicine department at Medical College of Wisconsin
Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Nirav N. Shah MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Databases, Factual
Hematopoietic Stem Cell Transplantation
Humans
Lymphoma, Non-Hodgkin
Medicare
Middle Aged
Survival Analysis
Transplantation Conditioning
Transplantation, Homologous
United States