HIGH-DOSE THERAPY AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR INTERMEDIATE-GRADE AND HIGH-GRADE NON-HODGKINS-LYMPHOMA IN PATIENTS AGED 55 YEARS AND OVER - RESULTS FROM THE EUROPEAN-GROUP-FOR-BONE-MARROW-TRANSPLANTATION

The results of high-dose therapy and autologous BMT for patients with intermediate/high grade NHL were analysed in 82 patients aged greater than or equal to 55 years, identified from the EBMT lymphoma database, These were compared with the results for 82 patients aged < 55 years who were matched on the basis of disease status at transplantation, presence of bone marrow or CNS involvement and closest date of transplantation. The 5 year actuarial progression-free survival (PFS) for patients aged < 55 years was 33% compared with 37% for the greater than or equal to 55 year group (p = 0.08). Corresponding figures for overall survival (OS) were 39% and 38%, respectively (p = 0.19). No difference in outcome was observed according to histological subtype. Although the number of patients receiving total body irradiation (TBI) is small, a significantly lower PFS was observed in patients greater than or equal to 55 years receiving TBI-based high-dose regimens compared with younger patients. This difference was due to a higher toxic death rate in the older patient group. In this retrospective matched analysis, age greater than or equal to 55 years was not associated with lower PFS or OS following high-dose therapy and autologous BMT. The increased toxic death rate in patients receiving TBI suggests that this should be avoided in older patients, who should receive chemotherapy only high-dose regimens.