Autologous Hemopoietic Stem Cell Transplantation In The Elderly Of Hematologic Malignancies

Background and ObjectiveAutologous hemopoietic stem cell transplantation (AHSCT) is popularily used in treatment of hematologic and nonhematologic malignancies. It can enhance the effect of radiotherapy and chemotherapy on tumor cells by strengthen the intensity, but it is always accompanied by the increasing of the toxicity of the drug. The endurance of the patient to AHSCT should be estimated exactly except for the sensitivity of the tumor to drugs in selection of candidate for AHSCT. Considering the atrophy of the hematologic system, the decreased immunity and the more underline diseases in elderly, incidence caused by toxicity of drugs andtransplant-related motality(TRM) might be higher in old patients and the tumor relapse rate also higher . So, the limitation of age under 60 or 65 to population receiving AHSCT was set in most units. But in recent years, there are many literatures that have reported successful works of performing AHSCT in old patients. This article aids to inquire into the feasibility of AHSCT in the elderly by analyses of 4 patients over the age of 65 years who were caught with hematologic malignancies and had been managed with AHSCT in our department from May 1999.MethodsFour cases of old patients over the age of 65 years with hematologic malignancies (3 cases of non-Hodgkin's lymphoma, 1 case of multiple myeloma) were treated with AHSCT in our department from May, 1999 to March, 2004. The diagnosis was confirmed by pathology or bone marrow puncture. The data about the therapy and situation of remission before transplantation, the intensive conditioning treatment and infusion course, the toxicity and effect after transplantation was analyzed and related literatures were reviewed.ResultsHemopoiesis was recovered after transplantation in the four cases. The median periods of neutrophil and platelet count recovery to 0.5 X109/L and 20 × 109/L were 13 days, respectively. It was similar to that in literatures. The major side-effects happened after AHSCT were fever, infection, hemorrhage caused by myeloablation and mucositis. No TRM occured. Two cases relapsed and finally died in 11 months and 4 months after AHSCT, the other two cases are still alive now.ConclusionsIt is feasible that carrying out AHSCT in the elderly with hematologic malignancies in the absence of severely compromised organ function or other accompanying illness. But relapse is the main reason that leads to death after AHSCT.