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Research from recent issues of Blood Advances
Post-Transplant High-Dose Chemotherapy Increases Risk of Toxicities in Older Patients With Lymphoma
Most patients with lymphoma who are over age 60 experience cardiovascular toxicities with high-dose chemotherapy and autologous hematopoietic cell transplantation ( AHCT ), but these patients tend to have similar 100-day and one-year non-relapse mortality , compared with younger patients , according to a study published in Blood Advances .
High-dose chemotherapy after AHCT , either as frontline therapy or in the relapsed / refractory setting , is an established therapeutic strategy for patients with lymphoma . Despite its efficacy , some studies suggest this approach may increase the risk of non-relapse mortality in patients older than 60 . In addition , few studies have been conducted to examine the risk-benefit ratio of post-AHCT high-dose chemotherapy in patients ≥70 years old .
In the study , led by Parastoo Dahi , MD , of Memorial Sloan Kettering Cancer Center ( MSKCC ), investigators retrospectively examined the toxicities associated with carmustine , etoposide , cytarabine , and melphalan ( BEAM ), and AHCT in 346 older patients with non-Hodgkin lymphoma ( NHL ). The patients were stratified by age : years , many patients developed severe toxicities . The median number of toxicities per patient in the older and younger groups were three and two , respectively .
Febrile neutropenia , gastrointestinal , infections , and cardiovascular toxicities were the most common severe toxicities reported in the overall population . Compared with the younger cohort , older patients had a significantly higher risk of grade ≥3 cardiovascular toxicities ( hazard ratio [ HR ]= 3.36 ; 95 % CI 2.25-5.00 ; p <. 001 ) and cutaneous toxicities ( HR = 2.45 ; 95 % CI 1.08-5.54 ; p = 0.032 ).
In patients age 70 and older , the non-relapse mortality rate at 100 days was 2.99 % ( 95 % CI 0.55-9.32 ), while the two-year non-relapse mortality rate in these patients was 6.2 % ( 95 % CI 1.97-13.95 ). The younger patients had 100-day and two-year respective non-relapse mortality rates of 1.79 % ( 95 % CI 0.68-3.92 ) and 2.91 % ( 95 % CI 1.37-5.42 ).
In an analysis adjusted for the number of grade 3 or higher toxicities within the first 100 days of transplant , patients age 70 and older had a 1.71-fold ( 95 % CI 1.08-2.71 ) higher risk of disease progression or death compared with younger patients .
According to a univariable regression analysis in the older cohort , those in partial remission had no increased risk of mortality ( HR = 2.26 ; 95 % CI 0.96-5.32 ), relapse ( HR = 2.21 ; 95 % CI 0.94-5.22 ), or death or progression ( HR = 1.71 ; 95 % CI 0.74-3.94 ) compared with patients in complete remission .
Limitations of this study include its retrospective design and the relatively small number of patients in the older cohort . Additionally , as only patients who proceeded to AHCT were included , these findings may not generalize to older patients with NHL who do not undergo transplant due to age , toxicity , comorbidity , or disease progression .
The authors report no relevant conflicts of interest .
Reference Dahi PB , Lee J , Devlin SM , et al . Toxicities of high-dose chemotherapy and autologous hematopoietic cell transplantation in older patients with lymphoma . Blood Adv . 2021 ; 5:2608-2618 .
• 60 to 69 years ( median age = 64.8 years ; n = 279 )
• ≥70 years ( median age = 71.8 years ; n = 67 )
Patients in this study underwent BEAM and AHCT between 2000 and 2018 at MSKCC . At the time of AHCT , a total of 136 patients had diffuse large B-cell lymphoma , 119 had mantle cell lymphoma , 21 had follicular lymphoma , 61 had T-cell NHL , and nine had other NHL subtypes .
The median age was 65.8 years , ranging from 60 to 77 years at the time of AHCT . Approximately 51.7 % of patients ( n = 179 ) received upfront consolidative AHCT . More than half of the cohort ( 54.6 %) received two or more lines of therapy before transplant . A total of 37 patients ( 10.5 %) received radiation therapy prior to AHCT .
The majority of patients ( n = 302 ) received an induction regimen comprising cyclophosphamide , doxorubicin , vincristine , and prednisone ( CHOP ) or a CHOP-like regimen . A combination of ifosfamide , carboplatin , and etoposide was the most common salvage therapy used in 109 patients .
Chemosensitive disease was reported in all patients . At baseline , both age groups had similar histology distribution , number of prior lines of therapy , remission status , hematopoietic cell transplantation comorbidity index , Karnofsky performance status , albumin level , and stem cell dose .
During the median follow-up period of 6.5
Pain , Comorbidities Increase Risk of Severe COVID-19 in Patients with SCD
Research published in Blood Advances found patients with sickle cell disease ( SCD ) and a history of pain and renal and heart / lung comorbidities have a higher risk of severe COVID-19 illness and worse outcomes related to the virus .
Pending further validation , these characteristics fill a significant knowledge gap and could be used to identify patients with SCD most at risk of developing serious COVID-19 , according to researchers led by Lana Mucalo , MD , from the Medical College of Wisconsin .
During the ongoing COVID-19 pandemic , mounting evidence has come to support an association between the presence of comorbidities and an increased risk of hospitalization . Comorbidities most linked to hospitalization for severe COVID-19 include diabetes , hypertension , cardiovascular disease ( CVD ), cerebrovascular disease , chronic obstructive pulmonary disease , obesity , and malignancy .
Previous research has also found that patients with SCD tend to have a higher prevalence of viral infections compared with the general population . To investigate the factors associated with hospitalization and severe COVID-19 disease in patients with SCD , the investigators evaluated a set of data on pediatric and adult patients with SCD who were registered in the international SECURE-SCD ( Surveillance Epidemiology of Coronavirus [ COVID-19 ] Under Research Exclusion for Sickle Cell Disease ) Registry , which relied on health care providers to report confirmed COVID-19 cases in patients with SCD .
The analysis included 364 children and 386 adults with SCD and COVID-19 who were reported in the registry between March 2020 and March 2021 .
In addition to the primary outcome of hospitalization and severe COVID-19 illness , the investigators assessed the prevalence of pain as a presenting symptom .
Most children ( 90.7 %) and adults ( 83.9 %) in the study were Black . At baseline , the median age was 11 in children and 31 in adults . More than
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