Patients ≥ age 40 years undergoing autologous or allogeneic BMT have regimen-related mortality rates and event-free survivals comparable to patients < age 40 years

To evaluate the safety and efficacy of marrow transplantation for older adults, the regimen-related mortality and event-free survival for patients ≥ 40 years were compared with those for patients < 40 years. Of 148 consecutive patients recieving autotransplants for lymphoma or Hodgkin's disease, 70 were < 40 years and 78 were ≥ 40 years at the time of time of transplant, including 40 who were ≥ 50 years and 12 who were ≥ 60 years. Eleven patients (16%) in the younger age group died from transplant-related complications compared with 4 (5%) in the older age group. The 4-year actuarial event-free survivals (EFS) for the younger and older age groups were 43% and 48%, respectively. After adjustment for covariates with prognostic significance, older age was marginally associated with improved event-free survival (P = 0.08). Of 92 consecutive patients undergoing allogeneic BMT during the same period, 62 patients were < 40 years and 30 patients were ≥ 40 years, including 8 patients ≥ 50 years, and 1 patient > 60 years. Non-relapse mortality (including deaths from GVHD) occurred in 28 of the younger patients (45%) and 9 of the older patients (30%). The 3-year actuarial EFS for the younger patients was 26% vs. 56% for the patients ≥ 40 years (P = 0.057). However, this difference was mainly due to the higher proportion of patients with CML and early-stage leukemia in the older age group. While older adults referred for transplantation may be selected, these data suggest that such patients exhibit treatment-related toxicity and event-free survival rates that are comparable to those of younger patients. Selection of patients on the basis of age alone should be discouraged.