When choosing which patients are eligible for blood stem cell transplants, age is usually one of the factors weighed in.
Now, a new study shows that at least for patients with non-Hodgkin’s lymphoma, age should not be a limiting factor on transplant eligibility, as it has no detrimental impact on the outcome of patients.
The results were recently presented at the 2018 Blood & Marrow Transplantation (BMT) Tandem Meetings, which took place in Salt Lake City, Utah, Feb. 21-25.
The study was titled “Outcomes of Patients 65 Years and Older with Non-Hodgkin Lymphoma Receiving Reduced-Intensity Conditioning Allogeneic Hematopoietic Stem Cell Transplantation Compared to Patients 55-64 Years of Age: A CIBMTR Analysis.”
Researchers at the Center for International Blood and Marrow Transplant Research (CIBMTR) performed a retrospective analysis of 1,629 patients with non-Hodgkin’s lymphoma (NHL) from several centers in the U.S. who underwent the transplant of blood-forming stem cells (allogeneic hematopoietic cell transplantation, or HCT).
The procedures were performed between 2008 and 2015 and patients had different subtypes of NHL, including follicular lymphoma, mantle cell lymphoma, diffuse large B-cell lymphoma, and mature T- or NK-cell lymphoma.
Researchers compared the outcomes of 1,183 patients ages 55-64 who received the transplant (median age 60) to 446 patients 65 and older (median age 68).
The analysis showed that age had no negative impact in patients’ four-year overall survival — 46% vs. 51% — and rate of disease relapse or progression — 42% vs. 41% — when comparing older to younger patients, respectively.
They also detected no significant differences in the reaction of donor immune cells against the patient’s healthy cells (grade 2-4), acute graft-versus-host disease (GVHD). After 180 days, 37% of the younger and 35% of the older patients developed this complication.
The incidence of chronic GVHD at two years post-transplant was also similar between both groups — 48% in the younger group and 45% in the older group.
“Age alone should not be a determining factor in the decision to refer older patients for transplant consultation to determine patient eligibility,” Nirav Shah, MD, the study’s lead author and assistant professor of medicine at the Medical College of Wisconsin’s Division of Hematology and Oncology, said in a press release.
“Advances in conditioning regimens and progress in post-transplant care have allowed more patients more than 65 years old or those with co-morbidities to undergo allogeneic HCT,” Shah said. “In 2017 alone, nearly 19 [percent] of transplant patients were more than 65 years old.”
Age is still used as a factor to limit patient’s access to HCT, and Medicare offers limited coverage for this indication in NHL patients 65 and older.
While states that are under the National Government Services jurisdiction cover stem cell transplants in lymphoma patients, there is a clear need to allow access to the therapy in patients from all states.
These results are part of a wider analysis to develop a new strategy for nationwide Centers for Medicare & Medicaid Services (CMS) coverage, said Susan N. Leppke, director of public and payer policy at NMDP/Be The Match, a global leader in bone marrow transplantation.
“We are excited about these results and we look forward to using this information to help shape our strategy to reduce access barriers for Medicare beneficiaries with lymphoma,” Leppke said.
