Autologous stem cell transplantation in multiple myeloma patients <60 vs ⩾60 years of age

Abstract

Summary:The role of autologous stem cell transplantation (AuSCT) in older multiple myeloma patients is unclear. Using data from the Autologous Blood and Marrow Transplant Registry, we compared the outcome of 110 patients Xthe age of 60 (median 63; range 60-73) years, undergoing AuSCT with that of 382 patients o60 (median 52; range 30-59) years. The two groups were similar except that older patients had a higher b 2 -microglobulin level at diagnosis (P ¼ 0.016) and fewer had lytic lesions (P ¼ 0.007). Day 100 mortality was 6% (95% confidence interval 4-9) and 1-year treatment-related mortality (TRM) was 9% (6-13) in patients o60 years, compared with 5% (2-10) and 8% (4-14), respectively, in patients X60 years. The relapse rate, progression-free survival (PFS) and overall survival (OS) in the two groups were also similar. Multivariate analysis of all patients identified only an interval from diagnosis to AuSCT 412 months and the use of two prior chemotherapy regimens within 6 months of AuSCT as adverse prognostic factors. Our results indicate that AuSCT can be safely performed in selected older patients: the best results were observed in patients undergoing AuSCT relatively early in their disease course.

Impact of age and serum creatinine value on outcome after autologous blood stem cell transplantation for patients with multiple myeloma

“…13 The groups were matched, except for b 2 -microglobulin levels and the number of lytic lesions. For older patients, the day-100 mortality rate was 6%, and the 1-year treatmentrelated mortality rate was 9%.…”

Autologous stem cell transplantation beyond 60 years of age

“…Excluding the registry analysis, 37 all other studies have used a high-dose MEL regimen (100-200 mg/m 2 ). In general, the response rates have been comparable to those of younger patients.…”

Autologous transplantation in elderly patients with multiple myeloma: are we asking the right questions?

“…Most studies have demonstrated similar TRM in older patients compared to younger patients when treated with the same conditioning regimens. 5,[22][23][24][25]26 The most striking increase in TRM was reported by Badros et al 4 in patients over age 70 treated with melphalan 200 mg/m 2 . Increased diarrhea and mucositis associated with age was reported in one study.…”

“…26 retrospectively analyzed the effect of age on overall and progression-free survival in 127 patients using age cutoffs of 55, 60 and 65 years and found no significant differences in outcomes. Reece et al 23 used tumor registry data to select 110 patients X 60 years of age and reported no difference in overall survival, disease-free survival and TRM compared to 382 younger patients. In contrast, Dumontet et al 21 reported decreased disease-free survival in a cohort of patients X60 years of age treated with ASCT.…”

“…Comorbidity assessment with the Charlson Comorbidity Index has been shown to be predictive of increased toxicity and mortality in allogeneic transplantation. 30,31 Sorror et al 32 refined this index to improve sensitivity and documented the reliability and Table 3 Influence of age on transplant-related toxicity in multiple myeloma 21 Retrospective, single institution 55 X60 No toxicity comparison by age Reece et al 23 Retrospective, multi-institution 492 X60 No difference in TRM Terpos et al 26 Retrospective, single institution 127…”