Evaluation of the Feasibility and Efficacy of Autologous Stem Cell Transplantation in Elderly Patients with Multiple Myeloma

Muta, Tsuyoshi; Miyamoto, Toshihiro; Fujisaki, Tomoaki; Ohno, Yuju; Kamimura, Tomohiko; Katô, Kôji; Takenaka, Katsuto; Iwasaki, Hiromi; Eto, Tetsuya; Takamatsu, Yasushi; Teshima, Takanori; Akashi, Koichi

doi:10.2169/internalmedicine.52.8390

Cited by 38 publications

(28 citation statements)

References 27 publications

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“…14–16 Nevertheless, some specific toxicities may occur with greater frequency among older patients with myeloma undergoing auto-HCT. For example, older adults may experience greater risk of cardiac toxicity (50% vs 10%; P <.0001), 17 arrhythmia (8% vs 0%; P =.02), 18 and oral/gastrointestinal toxicity (45% vs 23%; P =.06) 16 after auto-HCT. However, these age-related increases in toxicities have not been reported across all studies, and, in one report, older adults actually had less nausea than their younger counterparts (5% vs 18%; P =.007).…”

Section: Auto-hctmentioning

confidence: 99%

Hematopoietic Stem Cell Transplantation for Hematologic Malignancies in Older Adults: Geriatric Principles in the Transplant Clinic

Wildes¹,

Stirewalt

Medeiros

et al. 2014

J Natl Compr Canc Netw

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Hematopoietic cell transplantation (HCT) provides a life-prolonging or potentially curative treatment option for patients with hematologic malignancies. Given the high transplant-related morbidity, these treatment strategies were initially restricted to younger patients, but are increasingly being used in older adults. The incidence of most hematologic malignancies increases with age; with the aging of the population, the number of potential older candidates for HCT increases. Autologous HCT (auto-HCT) in older patients may confer a slightly increased risk of specific toxicities (such as cardiac toxicities and mucositis) and have modestly lower effectiveness (in the case of lymphoma). However, auto-HCT remains a feasible, safe, and effective therapy for selected older adults with multiple myeloma and lymphoma. Similarly, allogeneic transplant (allo-HCT) is a potential therapeutic option for selected older adults, although fewer data exist on allo-HCT in older patients. Based on currently available data, age alone is not the best predictor of toxicity and outcomes; rather, the comorbidities and functional status of the older patient are likely better predictors of toxicity than chronologic age in both the autologous and allogeneic setting. A comprehensive geriatric assessment (CGA) in older adults being considered for either an auto-HCT or allo-HCT may identify additional problems or geriatric syndromes, which may not be detected during the standard pretransplant evaluation. Further research is needed to establish the utility of CGA in predicting toxicity and to evaluate the quality of survival in older adults undergoing HCT.

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Section: Auto-hctmentioning

confidence: 99%

Hematopoietic Stem Cell Transplantation for Hematologic Malignancies in Older Adults: Geriatric Principles in the Transplant Clinic

Wildes¹,

Stirewalt

Medeiros

et al. 2014

J Natl Compr Canc Netw

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“…Based on these reports, elderly patients with MM in otherwise fit medical condition have been considered to be eligible for ASCT irrespective of the chronological age in many institutions [21,22]. Accordingly, several single institution studies have reported their experience of ASCT in elderly patients [23][24][25][26][27][28][29][30]. As conditioning regimen before ASCT, reduced dosing of melphalan (100-140mg/m2) has been predominantly used in elderly patients, with no significant difference in transplant-related mortality and morbidity between elderly and younger patients.…”

Section: Introductionmentioning

confidence: 99%

Autologous stem cell transplantation in elderly patients with multiple myeloma: evaluation of its safety and efficacy

Stettler

Novak

Baerlocher

et al. 2016

Leukemia & Lymphoma

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Administering high-dose chemotherapy (HDCT) with melphalan to elderly myeloma patients represents a challenge with respect to achieving therapeutic efficacy whilst avoiding significant toxicity. We analyzed safety and efficacy of HDCT in 61 elderly myeloma patients older than 65 years, including 12 patients ≥70 years, and compared them to 237 MM patients below 65 years treated in the same period. MM patients older than 70 years had a longer duration of hospitalization (26 vs. 20 days;P=.0001) and a longer time until platelet recovery >20 G/L (19 vs. 15 days; P=.0398). However, we observed no differences in the time until neutrophil recovery, infection rate, and treatment related mortality until 100 days after ASCT.Furthermore, higher age was not associated with inferior progression-free and overall survival at 1 and 2 years after ASCT. Our data suggest that HDCT with ASCT is feasible, safe and effective in MM patients older than 65 years. Stettler et alAutologous transplant in elderly myeloma patients.

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“…7 However, many subsequent studies, mostly retrospective or registry-based and performed before the latest drugs became available, have shown encouraging results with ASCT in patients over 65 years of age. [8][9][10][11][12][13] Some investigators even reported a successful outcome for patients over the age of 70.…”

mentioning

confidence: 99%

Upfront autologous stem cell transplantation for newly diagnosed elderly multiple myeloma patients: a prospective multicenter study

et al. 2016

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T he feasibility and efficacy of high-dose melphalan followed by autologous hematopoietic stem cell transplantation in newly diagnosed elderly patients with multiple myeloma was analyzed prospectively. Fifty-six multiple myeloma patients, aged 65 years or over, from 6 French centers were studied. The induction therapy was bortezomib-based in combination with dexamethasone and either thalidomide, cyclophosphamide or lenalidomide, for 4-6 cycles. Peripheral blood stem cells were collected after high-dose cyclophosphamide plus G-CSF or G-CSF alone, with plerixafor if needed. The conditioning regimen consisted of melphalan at 140 mg/m² in 18 patients (36%) and 200 mg/m 2 in 32 (64%). Three months post autologous hematopoietic stem cell transplantation, a 2-month consolidation phase with either lenalidomide plus dexamethasone or bortezomibbased combination therapy was allowed, but maintenance treatment was not given. All but 6 patients underwent autologous hematopoietic stem cell transplantation and 3 had tandem transplantations. The treatment-related mortality was 0% at 100 days post transplantation. Sixtyeight percent received consolidation therapy following transplantation. The best response achieved was 40% complete response, 36% very good partial response, and 18% partial response. After a median follow up of 21 months (range 6-31), the estimated progression-free and overall survival rates at two years were 76% [95%CI: (61.6-94.1)] and 88% [95%CI: (76.7-100)], respectively. The higher dose of melphalan (200 mg/m 2 ) afforded superior progression-free and overall survival rates. This prospective study provides evidence for the safety and efficacy of autologous hematopoietic stem cell transplantation as a first-line treatment approach in elderly multiple myeloma patients. (clinicaltrials.gov identifier: 01671826)

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Evaluation of the Feasibility and Efficacy of Autologous Stem Cell Transplantation in Elderly Patients with Multiple Myeloma

Cited by 38 publications

References 27 publications

Hematopoietic Stem Cell Transplantation for Hematologic Malignancies in Older Adults: Geriatric Principles in the Transplant Clinic

Hematopoietic Stem Cell Transplantation for Hematologic Malignancies in Older Adults: Geriatric Principles in the Transplant Clinic

Autologous stem cell transplantation in elderly patients with multiple myeloma: evaluation of its safety and efficacy

Upfront autologous stem cell transplantation for newly diagnosed elderly multiple myeloma patients: a prospective multicenter study

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