Treatment outcomes for older patients with relapsed/ refractory aggressive lymphoma receiving salvage chemotherapy and autologous stem cell transplantation are similar to younger patients: A subgroup analysis from the phase III CCTG LY.12 trial

Kelly Davison; B. E. Chen; V. Kukreti; S. Couban; A. Benger; N. L. Berinstein; L. Kaizer; P. Desjardins; J. Mangel; L. Zhu; M. S. Djurfeldt; A. E. Hay; L. E. Shepherd; M. Crump

doi:10.1093/annonc/mdw653

Treatment outcomes for older patients with relapsed/ refractory aggressive lymphoma receiving salvage chemotherapy and autologous stem cell transplantation are similar to younger patients: A subgroup analysis from the phase III CCTG LY.12 trial

Kelly Davison, B. E. Chen, V. Kukreti, S. Couban, A. Benger, N. L. Berinstein, L. Kaizer, P. Desjardins, J. Mangel, L. Zhu, M. S. Djurfeldt, A. E. Hay, L. E. Shepherd, M. Crump

Medicine

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Résumé

Background: High-dose therapy and autologous stem cell transplantation (ASCT) is often considered for older patients (age > 60 years) with relapsed/refractory aggressive lymphomas. Although registry data support the safety and potential efficacy of this approach, there are no prospective trials evaluating outcomes of ASCT in older patients. We evaluated the result of second-line chemotherapy and ASCT in older versus younger patients in the CCTG randomized LY.12 trial. Patients and methods: From August 2003 to November 2011, 619 patients with relapsed/refractory aggressive lymphoma were randomized to gemcitabine, dexamethasone, cisplatin (GDP) or dexamethasone, cytarabine, cisplatin (DHAP); 177 patients (28.6%) enrolled were > 60.0 years of age (range, 60-74) and 442 were ≤60.0 years of age. After two to three cycles, responding patients proceeded to ASCT. Intention-to-treat analysis was used to compare response rate, transplantation rate, event-free survival (EFS) and overall survival (OS) between patients aged≤60.0 and > 60.0 years. Results: Patient characteristics were comparable between the two cohorts, except a larger proportion of older patients had high International Prognostic Index risk scores. Response to salvage therapy was 48.6% for patients aged > 60.0 versus 43.0% for those aged ≤60.0 (P=0.21). Transplantation rates were also similar: 50.3% versus 49.8% (P=0.87) for older versus younger patients. Rates of febrile neutropenia and adverse events requiring hospitalization were comparable for older and younger patients (30.5% versus 22.9% and 37.9% versus 32.1%, respectively). With a median follow-up of 53 months, there was no difference in 4-year OS (36% and 40% for patients aged > 60.0 and≤60.0 years, P=0.42), or 4-year EFS (20% versus 28%, P=0.43). Mortality from salvage therapy was 8/174 (4.60%) and 5/436 (1.15%), and 100-day mortality post-ASCT was 7/88 (8.06%) and 4/ 219 (1.85%). Conclusion: This subgroup analysis suggests that older patients derive similar benefit from salvage therapy and ASCT to younger patients, with acceptable toxicity.

Langue d'origine	English
Pages (de-à)	622-627
Nombre de pages	6
Journal	Annals of Oncology
Volume	28
Numéro de publication	3
DOI	https://doi.org/10.1093/annonc/mdw653
Statut de publication	Published - mars 2017

Note bibliographique

Funding Information:
KD wrote the first draft of the manuscript, with input from MC, and all authors were involved in its final approval. MC, SC, LES and BEC were involved in trial design and protocol development. MC, SC, AEH, LS, BEC and LZ were involved in data analysis, while BEC and LZ carried out the statistical analyses. MC, VK, PD, SC, JM, AB, LK and NLB enrolled patients on the study. MSD provided administrative assistance. This work was supported by the Canadian Cancer Society Research Institute (grant numbers 015469, 021039), by Roche Canada (no applicable grant number) and by Eli Lilly Canada (no applicable grant number).

Publisher Copyright:
© The Author 2016.

ASJC Scopus Subject Areas

Hematology
Oncology

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Davison, K., Chen, B. E., Kukreti, V., Couban, S., Benger, A., Berinstein, N. L., Kaizer, L., Desjardins, P., Mangel, J., Zhu, L., Djurfeldt, M. S., Hay, A. E., Shepherd, L. E., & Crump, M. (2017). Treatment outcomes for older patients with relapsed/ refractory aggressive lymphoma receiving salvage chemotherapy and autologous stem cell transplantation are similar to younger patients: A subgroup analysis from the phase III CCTG LY.12 trial. Annals of Oncology, 28(3), 622-627. https://doi.org/10.1093/annonc/mdw653

Treatment outcomes for older patients with relapsed/ refractory aggressive lymphoma receiving salvage chemotherapy and autologous stem cell transplantation are similar to younger patients: A subgroup analysis from the phase III CCTG LY.12 trial. / Davison, Kelly; Chen, B. E.; Kukreti, V. et al.
Dans: Annals of Oncology, Vol. 28, N° 3, 03.2017, p. 622-627.

Résultat de recherche: Article › examen par les pairs

Davison, K, Chen, BE, Kukreti, V, Couban, S, Benger, A, Berinstein, NL, Kaizer, L, Desjardins, P, Mangel, J, Zhu, L, Djurfeldt, MS, Hay, AE, Shepherd, LE & Crump, M 2017, 'Treatment outcomes for older patients with relapsed/ refractory aggressive lymphoma receiving salvage chemotherapy and autologous stem cell transplantation are similar to younger patients: A subgroup analysis from the phase III CCTG LY.12 trial', Annals of Oncology, vol. 28, n° 3, pp. 622-627. https://doi.org/10.1093/annonc/mdw653

Davison K, Chen BE, Kukreti V, Couban S, Benger A, Berinstein NL et al. Treatment outcomes for older patients with relapsed/ refractory aggressive lymphoma receiving salvage chemotherapy and autologous stem cell transplantation are similar to younger patients: A subgroup analysis from the phase III CCTG LY.12 trial. Annals of Oncology. 2017 mars;28(3):622-627. doi: 10.1093/annonc/mdw653

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title = "Treatment outcomes for older patients with relapsed/ refractory aggressive lymphoma receiving salvage chemotherapy and autologous stem cell transplantation are similar to younger patients: A subgroup analysis from the phase III CCTG LY.12 trial",

abstract = "Background: High-dose therapy and autologous stem cell transplantation (ASCT) is often considered for older patients (age > 60 years) with relapsed/refractory aggressive lymphomas. Although registry data support the safety and potential efficacy of this approach, there are no prospective trials evaluating outcomes of ASCT in older patients. We evaluated the result of second-line chemotherapy and ASCT in older versus younger patients in the CCTG randomized LY.12 trial. Patients and methods: From August 2003 to November 2011, 619 patients with relapsed/refractory aggressive lymphoma were randomized to gemcitabine, dexamethasone, cisplatin (GDP) or dexamethasone, cytarabine, cisplatin (DHAP); 177 patients (28.6%) enrolled were > 60.0 years of age (range, 60-74) and 442 were ≤60.0 years of age. After two to three cycles, responding patients proceeded to ASCT. Intention-to-treat analysis was used to compare response rate, transplantation rate, event-free survival (EFS) and overall survival (OS) between patients aged≤60.0 and > 60.0 years. Results: Patient characteristics were comparable between the two cohorts, except a larger proportion of older patients had high International Prognostic Index risk scores. Response to salvage therapy was 48.6% for patients aged > 60.0 versus 43.0% for those aged ≤60.0 (P=0.21). Transplantation rates were also similar: 50.3% versus 49.8% (P=0.87) for older versus younger patients. Rates of febrile neutropenia and adverse events requiring hospitalization were comparable for older and younger patients (30.5% versus 22.9% and 37.9% versus 32.1%, respectively). With a median follow-up of 53 months, there was no difference in 4-year OS (36% and 40% for patients aged > 60.0 and≤60.0 years, P=0.42), or 4-year EFS (20% versus 28%, P=0.43). Mortality from salvage therapy was 8/174 (4.60%) and 5/436 (1.15%), and 100-day mortality post-ASCT was 7/88 (8.06%) and 4/ 219 (1.85%). Conclusion: This subgroup analysis suggests that older patients derive similar benefit from salvage therapy and ASCT to younger patients, with acceptable toxicity.",

author = "Kelly Davison and Chen, {B. E.} and V. Kukreti and S. Couban and A. Benger and Berinstein, {N. L.} and L. Kaizer and P. Desjardins and J. Mangel and L. Zhu and Djurfeldt, {M. S.} and Hay, {A. E.} and Shepherd, {L. E.} and M. Crump",

note = "Funding Information: KD wrote the first draft of the manuscript, with input from MC, and all authors were involved in its final approval. MC, SC, LES and BEC were involved in trial design and protocol development. MC, SC, AEH, LS, BEC and LZ were involved in data analysis, while BEC and LZ carried out the statistical analyses. MC, VK, PD, SC, JM, AB, LK and NLB enrolled patients on the study. MSD provided administrative assistance. This work was supported by the Canadian Cancer Society Research Institute (grant numbers 015469, 021039), by Roche Canada (no applicable grant number) and by Eli Lilly Canada (no applicable grant number). Publisher Copyright: {\textcopyright} The Author 2016.",

year = "2017",

month = mar,

doi = "10.1093/annonc/mdw653",

language = "English",

volume = "28",

pages = "622--627",

journal = "Annals of Oncology",

issn = "0923-7534",

publisher = "Oxford University Press",

number = "3",

}

TY - JOUR

T1 - Treatment outcomes for older patients with relapsed/ refractory aggressive lymphoma receiving salvage chemotherapy and autologous stem cell transplantation are similar to younger patients

T2 - A subgroup analysis from the phase III CCTG LY.12 trial

AU - Davison, Kelly

AU - Chen, B. E.

AU - Kukreti, V.

AU - Couban, S.

AU - Benger, A.

AU - Berinstein, N. L.

AU - Kaizer, L.

AU - Desjardins, P.

AU - Mangel, J.

AU - Zhu, L.

AU - Djurfeldt, M. S.

AU - Hay, A. E.

AU - Shepherd, L. E.

AU - Crump, M.

N1 - Funding Information: KD wrote the first draft of the manuscript, with input from MC, and all authors were involved in its final approval. MC, SC, LES and BEC were involved in trial design and protocol development. MC, SC, AEH, LS, BEC and LZ were involved in data analysis, while BEC and LZ carried out the statistical analyses. MC, VK, PD, SC, JM, AB, LK and NLB enrolled patients on the study. MSD provided administrative assistance. This work was supported by the Canadian Cancer Society Research Institute (grant numbers 015469, 021039), by Roche Canada (no applicable grant number) and by Eli Lilly Canada (no applicable grant number). Publisher Copyright: © The Author 2016.

PY - 2017/3

Y1 - 2017/3

N2 - Background: High-dose therapy and autologous stem cell transplantation (ASCT) is often considered for older patients (age > 60 years) with relapsed/refractory aggressive lymphomas. Although registry data support the safety and potential efficacy of this approach, there are no prospective trials evaluating outcomes of ASCT in older patients. We evaluated the result of second-line chemotherapy and ASCT in older versus younger patients in the CCTG randomized LY.12 trial. Patients and methods: From August 2003 to November 2011, 619 patients with relapsed/refractory aggressive lymphoma were randomized to gemcitabine, dexamethasone, cisplatin (GDP) or dexamethasone, cytarabine, cisplatin (DHAP); 177 patients (28.6%) enrolled were > 60.0 years of age (range, 60-74) and 442 were ≤60.0 years of age. After two to three cycles, responding patients proceeded to ASCT. Intention-to-treat analysis was used to compare response rate, transplantation rate, event-free survival (EFS) and overall survival (OS) between patients aged≤60.0 and > 60.0 years. Results: Patient characteristics were comparable between the two cohorts, except a larger proportion of older patients had high International Prognostic Index risk scores. Response to salvage therapy was 48.6% for patients aged > 60.0 versus 43.0% for those aged ≤60.0 (P=0.21). Transplantation rates were also similar: 50.3% versus 49.8% (P=0.87) for older versus younger patients. Rates of febrile neutropenia and adverse events requiring hospitalization were comparable for older and younger patients (30.5% versus 22.9% and 37.9% versus 32.1%, respectively). With a median follow-up of 53 months, there was no difference in 4-year OS (36% and 40% for patients aged > 60.0 and≤60.0 years, P=0.42), or 4-year EFS (20% versus 28%, P=0.43). Mortality from salvage therapy was 8/174 (4.60%) and 5/436 (1.15%), and 100-day mortality post-ASCT was 7/88 (8.06%) and 4/ 219 (1.85%). Conclusion: This subgroup analysis suggests that older patients derive similar benefit from salvage therapy and ASCT to younger patients, with acceptable toxicity.

AB - Background: High-dose therapy and autologous stem cell transplantation (ASCT) is often considered for older patients (age > 60 years) with relapsed/refractory aggressive lymphomas. Although registry data support the safety and potential efficacy of this approach, there are no prospective trials evaluating outcomes of ASCT in older patients. We evaluated the result of second-line chemotherapy and ASCT in older versus younger patients in the CCTG randomized LY.12 trial. Patients and methods: From August 2003 to November 2011, 619 patients with relapsed/refractory aggressive lymphoma were randomized to gemcitabine, dexamethasone, cisplatin (GDP) or dexamethasone, cytarabine, cisplatin (DHAP); 177 patients (28.6%) enrolled were > 60.0 years of age (range, 60-74) and 442 were ≤60.0 years of age. After two to three cycles, responding patients proceeded to ASCT. Intention-to-treat analysis was used to compare response rate, transplantation rate, event-free survival (EFS) and overall survival (OS) between patients aged≤60.0 and > 60.0 years. Results: Patient characteristics were comparable between the two cohorts, except a larger proportion of older patients had high International Prognostic Index risk scores. Response to salvage therapy was 48.6% for patients aged > 60.0 versus 43.0% for those aged ≤60.0 (P=0.21). Transplantation rates were also similar: 50.3% versus 49.8% (P=0.87) for older versus younger patients. Rates of febrile neutropenia and adverse events requiring hospitalization were comparable for older and younger patients (30.5% versus 22.9% and 37.9% versus 32.1%, respectively). With a median follow-up of 53 months, there was no difference in 4-year OS (36% and 40% for patients aged > 60.0 and≤60.0 years, P=0.42), or 4-year EFS (20% versus 28%, P=0.43). Mortality from salvage therapy was 8/174 (4.60%) and 5/436 (1.15%), and 100-day mortality post-ASCT was 7/88 (8.06%) and 4/ 219 (1.85%). Conclusion: This subgroup analysis suggests that older patients derive similar benefit from salvage therapy and ASCT to younger patients, with acceptable toxicity.

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