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-DabajaVaishalee 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

Research output: Contribution to journalArticle

13 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)933-940
Number of pages8
JournalBlood Advances
Volume2
Issue number8
DOIs
StatePublished - Apr 24 2018

ASJC Scopus subject areas

  • Hematology

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    Shah, N. N., Ahn, K. W., Litovich, C., Fenske, T. S., Ahmed, S., Battiwalla, M., Bejanyan, N., Dahi, P. B., Bolaños-Meade, J., Chen, A. I., Ciurea, S. O., Bachanova, V., DeFilipp, Z., Epperla, N., Farhadfar, N., Herrera, A. F., Haverkos, B. M., Holmberg, L., Hossain, N. M., ... Hamadani, M. (2018). Outcomes of Medicare-age eligible NHL patients receiving RIC allogeneic transplantation: A CIBMTR analysis. Blood Advances, 2(8), 933-940. https://doi.org/10.1182/bloodadvances.2018018531