Survival of Multiple Myeloma Patients Aged 65-70 Years in the Era of Novel Agents and Autologous Stem Cell Transplantation

Abstract

Novel agents such as thalidomide, lenalidomide and bortezomib have dramatically changed the treatment paradigm of multiple myeloma (MM). However, it is not clear whether these agents improve the prognosis of elderly patients who have undergone autologous stem cell transplantation (auto-SCT). We retrospectively analyzed the outcome of 318 newly diagnosed patients aged 65-70 years who were treated between January 1, 2004, and December 31, 2009. As initial therapy, 192 patients were treated with conventional chemotherapy, 88 with novel agent-containing regimens, 21 with conventional chemotherapy plus auto-SCT and the remaining 17 with novel agents plus auto-SCT. The median progression-free survival was 19.1, 24.5, 26.8 and 35.2 months, respectively, and the 5-year overall survival (OS) was 40, 62, 63 and 87%, respectively. Initial therapy with novel agents (p < 0.001) or auto-SCT (p < 0.02) significantly improved OS compared with the group without these treatment modalities. Salvage therapy with novel agents also significantly improved survival after relapse compared with conventional chemotherapy alone (p < 0.04). In a multivariate analysis, the use of novel agents was an independent prognostic factor significantly associated with extended OS (p < 0.003). These results indicate that novel agents and auto-SCT had a major impact on OS in eligible patients in this subgroup of MM.

The Shreveport Myeloma Experience: Survival, Risk Factors and Other Malignancies in the Age of Stem Cell Transplantation

“…Interestingly, the survival of patients older than 60 years is comparable to that of younger patients, which may be explained by the use of stem cell transplantation in the group of patients aged 60-69 years. This result somewhat differs from a large international database where the overall survival was shortened with each decade of life [26], but are consistent with recent data from a large reference center for MM and a large Japanese-European study [27,28]. …”

Cost-Effectiveness of Autologous Hematopoietic Stem Cell Transplantation for Elderly Patients with Multiple Myeloma using the Surveillance, Epidemiology, and End Results–Medicare Database

“…A recent Japanese retrospective analysis of patients ages 65 to 70 showed a 5-year OS of conventional chemotherapy and Auto HSCT of 63%. Further, for patients treated with novel agents and Auto HSCT, OS was 87% [33]. Although our 5-year survival is lower, we suspect this is related to short follow-up time for the more recent patients who were more likely to have received novel agents and to a greater diversity in patients.…”

Trends in survival of multiple myeloma: A thirty-year population-based study in a single institution

“…Several groups have reported on progressive OS improvement in MM [13][14][15][16][17][18][19][20][21][22][23][24]. Table 6 summarizes the results of the most relevant studies about survival in MM.…”