Efficacy and safety of autologous stem cell transplantation in patients aged ≥ 65 years with multiple myeloma in the era of novel agents

Abstract

Clinical trials evaluating the role of autologous hematopoietic stem cell transplantation (auto-HCT) in multiple myeloma have mostly included patients aged <65 years. Therefore, this study was aimed to evaluate the efficacy and safety of auto-HCT in elderly patients with multiple myeloma in the era of novel agents. We retrospectively analyzed 2056 patients with multiple myeloma, who underwent auto-HCT in 2007-2014 (287 were aged ≥65 years). We evaluated the 100-day treatment-related mortality (TRM) and overall survival (OS) in two groups; elderly patients (≥65 years) who underwent auto-HCT compared with younger patients (<65 years). In the propensity score-matched-pair analysis used to adjust for possible selection bias, the incidence of 100-day TRM between patients aged <65 (0.4%; 95% confidence interval [CI]: 0.0-2.0%) and ≥65 years (1.2%; 95% CI: 0.3-3.1%) showed no statistically significant difference (p = 0.31). The probability of the 5-year OS after transplantation in those aged <65 (62.5%; 95% CI: 58.6-66.1%) and ≥65 (63.5%; 95% CI: 52.2-72.7%) years was also not significantly different (p = 0.56). This study showed that the safety and efficacy of auto-HCT in elderly patients with multiple myeloma in the era of novel agents compared with younger patients were similar.

Transplant eligibility in elderly multiple myeloma patients: Prospective external validation of the international myeloma working group frailty score and comparison with clinical judgment and other comorbidity scores in unselected patients aged 65‐75 years

“…Moreover, data from both groups suggest that selected elderly patients receiving ASCT have similar outcome to those of younger patients. Similar results have been more recently confirmed from Japanese registry data 26 . Furthermore, the advent of novel agents may have contributed to improve outcomes, allowing a higher number of patients to undergo ASCT in better clinical conditions and with a lower disease burden 27 .…”

“…Similar results have been more recently confirmed from Japanese registry data. 26 Furthermore, the advent of novel agents may have contributed to improve outcomes, allowing a higher number of patients to undergo ASCT in better clinical conditions and with a lower disease burden. 27 The role of ASCT in older adults MM patients have been investigated by several retrospective single center studies.…”

Trends in disease indications for hematopoietic stem cell transplantation in the Asia-Pacific region: A report of the Activity Survey 2017 from APBMT

“…Recently, transplant outcomes of multiple myeloma have been improving by combining novel agents (NA), second-generation proteasome inhibitors, third-generation immunomodulators, and antibody drugs with induction therapy 22 . In fact, despite being a common disease in older patients, some reports from Europe and Japan, where aging is progressing, showed that autologous transplants for MM in that population were safe and effective 23,24 . Thus, the number of autologous transplants for MM is expected to increase in the future.…”

Guidelines on the diagnosis and management of multiple myeloma treatment: Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular Project guidelines: Associação Médica Brasileira – 2022. Part I

“…Regarding overall survival (OS) , comparing the non-elderly group with the elderly group after five years of median follow-up, we found a higher rate of OS in patients younger than 65 years (58.2% [95%CI, 54.2-62.1%]) when compared to those older than 65 years (42.6% [95%CI, 31.6-53.2%]). 2 It was also shown that after three years, there was a higher OS in the 18 to 59-year-old group (78% [95%CI, 76-79]) when compared to the patients aged 70 years and older (72% [95%CI, 67-76]). 3 When it comes to progression-free survival (PFS) , there was no significant difference between the elderly and non-elderly.…”