Transplant-related mortality in patients older than 60 years undergoing autologous hematopoietic stem cell transplantation

Although high-dose therapy with autologous hematopoietic stem cell transplantation (ASCT) is a widely used method of dose intensification in patients with hematological malignancies, patients aged over 60 are generally excluded, We evaluated high-dose therapy and ASCT in 29 cases involving 27 such patients (median age 63 years; range 61-68) with different malignancies, Patients were eligible if they had a good performance status, normal cardiac, respiratory, and hepatic function and a serum creatinine concentration of less than 2 mg/dl (<5 mg/dl in myeloma patients), Engraftment was assessable in 27 procedures. The median time to attain 0.5 and 1 x 10(9) PMN/l was 13 days (range 9-30) and 14 days (range 10-66), respectively, The median time taken to reach a platelet count greater than 50 x 10(9)/l was 14 days (range 8-223), Five patients (17%) died in the first 100 days after transplant, in two cases due to disease progression. The remaining three patients died as a consequence of transplant-related complications, with an overall transplant-related mortality of 10%, Five patients relapsed and died between 5 and 36 months after transplant, The remaining 17 patients are still alive without disease progression, with an actuarial overall survival of 47 % at 42 months (95 % CI 33-61), We consider that high-dose therapy with ASCT should be considered in those elderly patients with good performance status and without general organ impairment.