Cardiovascular toxicity is increased, but manageable, during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for patients aged 60 years and older
High-dose therapy (HDT) for non-Hodgkins lymphoma (NHL) and multiple myeloma (MM) is considered a feasible option for patients aged 60 years. This study compared the outcomes for all patients aged 60 years treated with HDT at the center to a matched cohort group aged
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| Veröffentlicht in: | Leukemia & lymphoma 2005-11, Vol.46 (11), p.1575-1579 |
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| creator | Mileshkin, L. R. Seymour, J. F. Wolf, M. M. Gates, P. Januszewicz, E. H. Joyce, P. Prince, H. M. |
| description | High-dose therapy (HDT) for non-Hodgkins lymphoma (NHL) and multiple myeloma (MM) is considered a feasible option for patients aged 60 years. This study compared the outcomes for all patients aged 60 years treated with HDT at the center to a matched cohort group aged |
| doi_str_mv | 10.1080/10428190500235884 |
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R. ; Seymour, J. F. ; Wolf, M. M. ; Gates, P. ; Januszewicz, E. H. ; Joyce, P. ; Prince, H. M.</creator><creatorcontrib>Mileshkin, L. R. ; Seymour, J. F. ; Wolf, M. M. ; Gates, P. ; Januszewicz, E. H. ; Joyce, P. ; Prince, H. M.</creatorcontrib><description>High-dose therapy (HDT) for non-Hodgkins lymphoma (NHL) and multiple myeloma (MM) is considered a feasible option for patients aged 60 years. This study compared the outcomes for all patients aged 60 years treated with HDT at the center to a matched cohort group aged <60 years. Results for patients who were 60 years at HDT between 1997 - 2002 were retrospectively analysed to assess efficacy and safety. Event-free (EFS) and overall survival (OS) rates were compared with a cohort group, matched by disease type, chemotherapy sensitivity, year of treatment and conditioning regimen. Patients with NHL were also matched by International Prognostic Index score. Forty patients aged 60 years were identified. Median age was 65 (range 60 - 76) with 22 MM and 18 NHL; 50% had 1 or more co-morbidity; 35% had cardiovascular co-morbidity vs. 18% of controls (p = 0.075). Response rates (RR) following HDT for MM were: 4 (18%) complete responses (CR) and 18 (82%) partial responses (PR), giving an overall response rate (ORR) of 100%, vs. 77% for controls (p = 0.02). For NHL patients there were: 8 CR (44%) and 4 PR (22%), giving an ORR of 67%, vs. 83% for controls (p = 0.3). Transplant-related mortality was 8% compared to 5% in controls (p = 0.6). Toxicities were similar with the exception of cardiac toxicity, which was significantly higher in patients aged 60 years vs. controls (50% grade 3 vs. 10%: p < 0.0001). Atrial fibrillation was the most frequent cardiovascular toxicity (9 patients). At a median follow-up of 33 months, there is no significant difference between older vs. younger patients in median EFS (24 vs. 38 months: p = 0.78) or OS (40 months vs. not reached: p = 0.23). HDT is feasible and effective in selected patients 60 years with MM and NHL. Patients 60 years are more susceptible to cardiovascular toxicities, particularly atrial fibrillation, but have similar or better response rates following HDT and similar long-term outcomes to younger patients.</description><identifier>ISSN: 1042-8194</identifier><identifier>EISSN: 1029-2403</identifier><identifier>DOI: 10.1080/10428190500235884</identifier><identifier>PMID: 16236612</identifier><language>eng</language><publisher>United States: Informa UK Ltd</publisher><subject>Adult ; Age Factors ; Aged ; Antineoplastic Combined Chemotherapy Protocols - adverse effects ; Cardiovascular Diseases - chemically induced ; Case-Control Studies ; Drug-Related Side Effects and Adverse Reactions ; Elderly ; Female ; high-dose therapy ; Humans ; Lymphoma, Non-Hodgkin - complications ; Lymphoma, Non-Hodgkin - drug therapy ; Lymphoma, Non-Hodgkin - mortality ; Male ; Middle Aged ; multiple myeloma ; Multiple Myeloma - complications ; Multiple Myeloma - drug therapy ; Multiple Myeloma - mortality ; non-Hodgkins lymphoma ; Peripheral Blood Stem Cell Transplantation - adverse effects ; Prognosis ; Retrospective Studies ; Survival Analysis ; transplantation ; Transplantation, Autologous</subject><ispartof>Leukemia & lymphoma, 2005-11, Vol.46 (11), p.1575-1579</ispartof><rights>2005 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted 2005</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c435t-71d2e189b0b7a7b817b426d15b835785390f181b3ccdce0eba4c4fd1182f2c643</citedby><cites>FETCH-LOGICAL-c435t-71d2e189b0b7a7b817b426d15b835785390f181b3ccdce0eba4c4fd1182f2c643</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.tandfonline.com/doi/pdf/10.1080/10428190500235884$$EPDF$$P50$$Ginformahealthcare$$H</linktopdf><linktohtml>$$Uhttps://www.tandfonline.com/doi/full/10.1080/10428190500235884$$EHTML$$P50$$Ginformahealthcare$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,59647,59753,60436,60542,61221,61256,61402,61437</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16236612$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Mileshkin, L. R.</creatorcontrib><creatorcontrib>Seymour, J. F.</creatorcontrib><creatorcontrib>Wolf, M. M.</creatorcontrib><creatorcontrib>Gates, P.</creatorcontrib><creatorcontrib>Januszewicz, E. H.</creatorcontrib><creatorcontrib>Joyce, P.</creatorcontrib><creatorcontrib>Prince, H. M.</creatorcontrib><title>Cardiovascular toxicity is increased, but manageable, during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for patients aged 60 years and older</title><title>Leukemia & lymphoma</title><addtitle>Leuk Lymphoma</addtitle><description>High-dose therapy (HDT) for non-Hodgkins lymphoma (NHL) and multiple myeloma (MM) is considered a feasible option for patients aged 60 years. This study compared the outcomes for all patients aged 60 years treated with HDT at the center to a matched cohort group aged <60 years. Results for patients who were 60 years at HDT between 1997 - 2002 were retrospectively analysed to assess efficacy and safety. Event-free (EFS) and overall survival (OS) rates were compared with a cohort group, matched by disease type, chemotherapy sensitivity, year of treatment and conditioning regimen. Patients with NHL were also matched by International Prognostic Index score. Forty patients aged 60 years were identified. Median age was 65 (range 60 - 76) with 22 MM and 18 NHL; 50% had 1 or more co-morbidity; 35% had cardiovascular co-morbidity vs. 18% of controls (p = 0.075). Response rates (RR) following HDT for MM were: 4 (18%) complete responses (CR) and 18 (82%) partial responses (PR), giving an overall response rate (ORR) of 100%, vs. 77% for controls (p = 0.02). For NHL patients there were: 8 CR (44%) and 4 PR (22%), giving an ORR of 67%, vs. 83% for controls (p = 0.3). Transplant-related mortality was 8% compared to 5% in controls (p = 0.6). Toxicities were similar with the exception of cardiac toxicity, which was significantly higher in patients aged 60 years vs. controls (50% grade 3 vs. 10%: p < 0.0001). Atrial fibrillation was the most frequent cardiovascular toxicity (9 patients). At a median follow-up of 33 months, there is no significant difference between older vs. younger patients in median EFS (24 vs. 38 months: p = 0.78) or OS (40 months vs. not reached: p = 0.23). HDT is feasible and effective in selected patients 60 years with MM and NHL. Patients 60 years are more susceptible to cardiovascular toxicities, particularly atrial fibrillation, but have similar or better response rates following HDT and similar long-term outcomes to younger patients.</description><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Antineoplastic Combined Chemotherapy Protocols - adverse effects</subject><subject>Cardiovascular Diseases - chemically induced</subject><subject>Case-Control Studies</subject><subject>Drug-Related Side Effects and Adverse Reactions</subject><subject>Elderly</subject><subject>Female</subject><subject>high-dose therapy</subject><subject>Humans</subject><subject>Lymphoma, Non-Hodgkin - complications</subject><subject>Lymphoma, Non-Hodgkin - drug therapy</subject><subject>Lymphoma, Non-Hodgkin - mortality</subject><subject>Male</subject><subject>Middle Aged</subject><subject>multiple myeloma</subject><subject>Multiple Myeloma - complications</subject><subject>Multiple Myeloma - drug therapy</subject><subject>Multiple Myeloma - mortality</subject><subject>non-Hodgkins lymphoma</subject><subject>Peripheral Blood Stem Cell Transplantation - adverse effects</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Survival Analysis</subject><subject>transplantation</subject><subject>Transplantation, Autologous</subject><issn>1042-8194</issn><issn>1029-2403</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kUuLFDEUhQtRnHH0B7iRrFxNaR71SKEbaXzBgBtdFzfJra4MqaRMUqP9t_yFpu0GEWFWuZDvnNycU1XPGX3FqKSvGW24ZANtKeWilbJ5UF0yyoeaN1Q8PM4NrwvQXFRPUrqllLZDxx9XF6zjousYv6x-7SAaG-4g6c1BJDn8tNrmA7GJWK8jQkJzTdSWyQIe9gjK4TUxW7R-T2a7n2sTEhI94xLyjBHWAwFvCGw5uLAPWyIrRrserxxRLgRDUsaFaHSO5Ag-rQ58hmyDJ1OIZC0j-pxIec2QjpIDQkx_TIMzGJ9WjyZwCZ-dz6vq24f3X3ef6psvHz_v3t3UuhFtrntmODI5KKp66JVkvWp4Z1irpGh72YqBTkwyJbQ2GikqaHQzGcYkn7juGnFVvTz5rjF83zDlcbHpuDV4LN8a2dCJXlJWQHYCdQwpRZzGNdoF4mFkdDwWNf5XVNG8OJtvakHzV3FupgBvT4D1JZQFfoTozJjh4EKcSmraplHc5__mH_mM4PKsIeJ4G7boS3D3bPcbQWS3UA</recordid><startdate>20051101</startdate><enddate>20051101</enddate><creator>Mileshkin, L. 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R.</creatorcontrib><creatorcontrib>Seymour, J. F.</creatorcontrib><creatorcontrib>Wolf, M. M.</creatorcontrib><creatorcontrib>Gates, P.</creatorcontrib><creatorcontrib>Januszewicz, E. H.</creatorcontrib><creatorcontrib>Joyce, P.</creatorcontrib><creatorcontrib>Prince, H. M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Leukemia & lymphoma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Mileshkin, L. R.</au><au>Seymour, J. F.</au><au>Wolf, M. M.</au><au>Gates, P.</au><au>Januszewicz, E. H.</au><au>Joyce, P.</au><au>Prince, H. M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Cardiovascular toxicity is increased, but manageable, during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for patients aged 60 years and older</atitle><jtitle>Leukemia & lymphoma</jtitle><addtitle>Leuk Lymphoma</addtitle><date>2005-11-01</date><risdate>2005</risdate><volume>46</volume><issue>11</issue><spage>1575</spage><epage>1579</epage><pages>1575-1579</pages><issn>1042-8194</issn><eissn>1029-2403</eissn><abstract>High-dose therapy (HDT) for non-Hodgkins lymphoma (NHL) and multiple myeloma (MM) is considered a feasible option for patients aged 60 years. This study compared the outcomes for all patients aged 60 years treated with HDT at the center to a matched cohort group aged <60 years. Results for patients who were 60 years at HDT between 1997 - 2002 were retrospectively analysed to assess efficacy and safety. Event-free (EFS) and overall survival (OS) rates were compared with a cohort group, matched by disease type, chemotherapy sensitivity, year of treatment and conditioning regimen. Patients with NHL were also matched by International Prognostic Index score. Forty patients aged 60 years were identified. Median age was 65 (range 60 - 76) with 22 MM and 18 NHL; 50% had 1 or more co-morbidity; 35% had cardiovascular co-morbidity vs. 18% of controls (p = 0.075). Response rates (RR) following HDT for MM were: 4 (18%) complete responses (CR) and 18 (82%) partial responses (PR), giving an overall response rate (ORR) of 100%, vs. 77% for controls (p = 0.02). For NHL patients there were: 8 CR (44%) and 4 PR (22%), giving an ORR of 67%, vs. 83% for controls (p = 0.3). Transplant-related mortality was 8% compared to 5% in controls (p = 0.6). Toxicities were similar with the exception of cardiac toxicity, which was significantly higher in patients aged 60 years vs. controls (50% grade 3 vs. 10%: p < 0.0001). Atrial fibrillation was the most frequent cardiovascular toxicity (9 patients). At a median follow-up of 33 months, there is no significant difference between older vs. younger patients in median EFS (24 vs. 38 months: p = 0.78) or OS (40 months vs. not reached: p = 0.23). HDT is feasible and effective in selected patients 60 years with MM and NHL. Patients 60 years are more susceptible to cardiovascular toxicities, particularly atrial fibrillation, but have similar or better response rates following HDT and similar long-term outcomes to younger patients.</abstract><cop>United States</cop><pub>Informa UK Ltd</pub><pmid>16236612</pmid><doi>10.1080/10428190500235884</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; Taylor & Francis Medical Library - CRKN; Taylor & Francis Journals Complete |
| subjects | Adult Age Factors Aged Antineoplastic Combined Chemotherapy Protocols - adverse effects Cardiovascular Diseases - chemically induced Case-Control Studies Drug-Related Side Effects and Adverse Reactions Elderly Female high-dose therapy Humans Lymphoma, Non-Hodgkin - complications Lymphoma, Non-Hodgkin - drug therapy Lymphoma, Non-Hodgkin - mortality Male Middle Aged multiple myeloma Multiple Myeloma - complications Multiple Myeloma - drug therapy Multiple Myeloma - mortality non-Hodgkins lymphoma Peripheral Blood Stem Cell Transplantation - adverse effects Prognosis Retrospective Studies Survival Analysis transplantation Transplantation, Autologous |
| title | Cardiovascular toxicity is increased, but manageable, during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for patients aged 60 years and older |
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