Introduction Multiple myeloma (MM) is a disease of elderly with median age of diagnosis 66-years. Autologous hematopoietic stem cell transplantation (auto-HCT) is recommended for eligible patients with newly diagnosed MM, however, it is not offered to many elderly patients due to concerns of excessive toxicity. We have previously reported that auto-HCT can be safely performed in myeloma patients aged ≥ 70 years (Bashir et al. L&L 2012). Here we report the results of a retrospective analysis of MM patients aged ≥ 75 years who underwent auto-HCT at our center. Methods All myeloma patients aged ≥ 75 years who underwent auto-HCT at our institution between 1/1/2000 and 12/31/2015 were retrospectively analyzed. Frequencies of toxicities were compared using Fisher's exact test. The cumulative incidence (CI) of non-relapse mortality (NRM) was assessed using the competing risks method. The Kaplan-Meier method was used to estimate overall survival (OS) and progression-free survival (PFS). Differences in survival between groups were assessed using the log-rank test. The association between survival and patient subgroups of interest was determined using univariate and multivariable Cox proportional hazards regression models. Results 72 patients (median age 76 years; 58% male) were included in the study. Thirty percent (n=19/63) were ISS stage I, 43% (n=27/63) were stage II and 27% (n=17/63) stage III. Seventy-eight percent (n=56) were considered standard-risk (IMWG criteria) and 22% (n=16) had high-risk cytogenetics. Sixty-three percent (n=45) received conditioning with melphalan (MEL) 140 mg/m2, while 38% (n=27) received MEL >140. Seventy-five percent (n=54) of the patients received auto-HCT as part of first line therapy and 85% (n=61) had at least partial response (PR) at auto-HCT. Median time from diagnosis to auto-HCT was 7.6 months. Half of the patients (n=36) received post transplant maintenance. Median follow-up time for all survivors (n=48) was 25.5 months. Grade II-IV toxicity was seen in 74% (n=53) of patients, gastrointestinal being most common (49% of all patients). There was no difference in toxicity between MEL 140 vs. MEL >140. The median time to neutrophil and platelet engraftment was 11 and 12 days, respectively. The CI of NRM was 1% at Day 100 and 6 months and 4% at the end of the assessment period. Day 100 response rate (at least PR) was 92% (n=66), with 36% (n=26) achieving near complete remission (nCR) or better. Median PFS was 31.4 months (95% CI: 22.6, 36.6, Figure 1). Seventy-five percent of the patients were event free at one year after transplant and 23% were event free at 5 years. Median OS was 72.8 months (95% CI: 45.7, 86.2, Figure 2). The OS rates at 1 year and 5 years post transplant were 93% and 58%, respectively. On multivariable analysis, high-risk cytogenetics and ISS stage III disease were associated with significantly worse PFS and OS. Conclusion Auto-HCT in myeloma patients aged ≥ 75 years is feasible with response rate and survival comparable to that seen in younger patients. Age alone should not be used to determine eligibility for auto-HCT. Figure 1 Progression-free survival (all patients). Figure 1. Progression-free survival (all patients). Figure 2 Overall survival (all patients). Figure 2. Overall survival (all patients). Disclosures Ciurea: Cyto-Sen Therapeutics: Equity Ownership; Spectrum Pharmaceuticals: Other: Advisory Board.
Background: Large randomized trials have shown that maintenance therapy after autologous hematopoietic cell transplantation (auto-HCT)
Data regarding the presentation and outcome of pediatric malignancies in northern Egypt, a resource-limited area, is limited. Alexandria School of Medicine (ASM) is the only center in Northern Egypt providing therapy to children with oncologic conditions. It serves 4 governorates and a population of 20 million. Initially children were treated as part of a combined adult/pediatric oncology service with therapy based on active adult protocols. In January 2010 a dedicated pediatric oncology service was created and staffed with providers specifically trained to care for children;international pediatric protcols were employed. We here present a comparison of outcomes achieved in children diagnosed with non-Hodgkin's lymphoma (NHL) before and after launching this service. Methods A retrospective review of patients <20 years old with NHL treated at ASM was performed. Those treated from 1/1999 to 12/2009 were the historical cohort. This group was compared to patients treated between 1/2010-12/ 2012 on the pediatric service. Results There were a total of 92 cases diagnosed with NHL in the historical cohort. This represented 23% of the total pediatric non-leukemic malignancies seen in this time at ASM. 38 cases of NHLwere diagnosed after the pediatric service opened representing 6% of the pediatric non-leukemic malignancies. In the historical group the most common presentation was abdominal mass (35%) followed by mediastinal lymphadenopathy (26%) , head and neck adenopathy (13%), pancytopenia (20%) , CNS involvement (10%) and other manifestations (10%). After the launch the most common presentation was abdominal mass (63%) followed by mediastinal adenopathy (18%) , pancytopenia ( 18%), head and neck adenopathy (15%) and other manifestations (8 %). ( Totals are >100% as some children had > one symptom at presentation.) Staging was done according to St. Jude classification of NHL. Historically the majority of patients presented with stage IV disease ( 51%). 25% were Stage III, 19% stage II and 5% stage I. After the launch the most common stage at presentation was stage II ( 42%) followed by stage III (40%) , stage IV ( 16%) and stage I ( 3%). Diagnosis of lymphoma was pathologically proven in 80% and 20% were treated based on clinical/radiologic signs and symptoms. Histopathological diagnosis in the older cohort were Burkitt lymphoma (39%), Lymphoblastic Lymphoma (30%), Diffuse large B cell lymphoma (DLBCL) (20%) and anaplastic lymphoma (ALCL) (11%). After the launch diagnoses were Burkitt lymphoma (63%), Lymphoblastic Lymphoma (15%), DLBCL (13%), ALCL (5%) and Natural Killer Cell lymphoma (4%). In the historical group pediatric patients were treated on adult protocols in use at that time. 60% received only chemotherapy 35% were treated with a combination chemotherapy/radiotherapy and 5% were treated with radiotherapy as the sole modality. After the launch patients were treated on internationally published pediatric protocols employing multiagent chemotherapy. No patients in this group received radiation therapy. With a follow up period of 24-132 (mean 49) months, 25% of historical patients succumbed to disease or therapy related complications for a disease free survival of 75%. After the establishment of a pediatric service with a follow up of 3-30 (mean 12) months 13% had died for a disease free survival of 87% ( p= 0.17). Conclusion NHL is one of the most common pediatric oncologic diagnoses and patients in developed countries have very good outcomes with > 80% survival on current protcols. At ASM, where the majority of children residing in northern Egypt receive their oncology care, children were treated as part of an adult oncology service, a common occurrence when resources are limited. 3 years ago the need for a dedicated pediatric service was recognized. We here compare outcomes for children with NHL before and after the establishment of this service. The subtypes seen are similar to those in Northern America and Europe and do not differ between the 2 periods. However disease free survival significantly improved in the recent era and is now similar to international norms. These results indicate that despite limitations encountered in this setting developing a dedicated pediatric oncology program can postivilet impact outcomes in addition to creating a platform for prospective data collection and practice improvement that will continue to improve results for these unfortunate children. Disclosures: No relevant conflicts of interest to declare.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.