Blood Advances (Apr 2018)
Outcomes of Medicare-age eligible NHL patients receiving RIC allogeneic transplantation: a CIBMTR analysis
- Nirav N. Shah,
- Kwang Woo Ahn,
- Carlos Litovich,
- Timothy S. Fenske,
- Sairah Ahmed,
- Minoo Battiwalla,
- Nelli Bejanyan,
- Parastoo B. Dahi,
- Javier Bolaños-Meade,
- Andy I. Chen,
- Stefan O. Ciurea,
- Veronika Bachanova,
- Zachariah DeFilipp,
- Narendranath Epperla,
- Nosha Farhadfar,
- Alex F. Herrera,
- Bradley M. Haverkos,
- Leona Holmberg,
- Nasheed M. Hossain,
- Mohamed A. Kharfan-Dabaja,
- Vaishalee P. Kenkre,
- Hillard M. Lazarus,
- Hemant S. Murthy,
- Taiga Nishihori,
- Andrew R. Rezvani,
- Anita D'Souza,
- Bipin N. Savani,
- Matthew L. Ulrickson,
- Edmund K. Waller,
- Anna Sureda,
- Sonali M. Smith,
- Mehdi Hamadani
Affiliations
- Nirav N. Shah
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI;
- Kwang Woo Ahn
- Division of Biostatistics, Institute for Health and Society, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI;; Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI;
- Carlos Litovich
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI;
- Timothy S. Fenske
- Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI;
- Sairah Ahmed
- MD Anderson Cancer Center, University of Texas, Houston, TX;
- Minoo Battiwalla
- Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD;
- Nelli Bejanyan
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN;
- Parastoo B. Dahi
- Adult Bone Marrow Transplant Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY;
- Javier Bolaños-Meade
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD;
- Andy I. Chen
- Oregon Health and Science University, Portland, OR;
- Stefan O. Ciurea
- MD Anderson Cancer Center, University of Texas, Houston, TX;
- Veronika Bachanova
- Bone and Marrow Transplant Program, University of Minnesota Medical Center, Minneapolis, MN;
- Zachariah DeFilipp
- Blood and Marrow Transplant Program, Massachusetts General Hospital, Boston, MA;
- Narendranath Epperla
- Division of Hematology, The James Cancer Center and Solove Research Institute, The Ohio State University, Columbus, OH;
- Nosha Farhadfar
- University of Florida, Gainesville, FL;
- Alex F. Herrera
- City of Hope, Duarte, CA;
- Bradley M. Haverkos
- University of Colorado Hospital, Aurora, CO;
- Leona Holmberg
- Fred Hutchinson Cancer Research Center, Seattle, WA;
- Nasheed M. Hossain
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA;
- Mohamed A. Kharfan-Dabaja
- Blood and Marrow Transplantation Program, Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL;
- Vaishalee P. Kenkre
- University of Wisconsin, Madison, WI;
- Hillard M. Lazarus
- Seidman Cancer Center, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH;
- Hemant S. Murthy
- University of Florida, Gainesville, FL;
- Taiga Nishihori
- Department of Blood and Marrow Transplant and Cellular Immunotherapy, H. Lee Moffitt Cancer Center, Tampa, FL;
- Andrew R. Rezvani
- Division of Blood and Marrow Transplantation, Stanford University School of Medicine, Stanford, CA;
- Anita D'Souza
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI;
- Bipin N. Savani
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN;
- Matthew L. Ulrickson
- Banner MD Anderson Cancer Center, Gilbert, AZ;
- Edmund K. Waller
- Department of Hematology and Oncology, Winship Cancer Institute, Emory University, Atlanta, GA;
- Anna Sureda
- Hematology Department, Institut Català d'Oncologia–Hospitalet, Barcelona, Spain;
- Sonali M. Smith
- Section of Hematology/Oncology, The University of Chicago, Chicago, IL
- Mehdi Hamadani
- Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI;; Mehdi Hamadani, Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Suite C5500, Milwaukee, WI 53226;
- Journal volume & issue
-
Vol. 2,
no. 8
pp. 933 – 940
Abstract
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.
