Summary:We studied the effect of the CD34 ؉ cell dose on transplant-related mortality (TRM) and survival in 39 patients randomized to receive lenograstim-mobilized PBSCT (n = 20) or BMT (n = 19) from HLA-identical siblings. Both marrow and blood were harvested, and one infused in a double-blind fashion. The median nucleated
Summary:Autologous stem cell transplantation after high-dose melphalan for the treatment with multiple myeloma has resulted in prolonged progression-free survival and overall survival in patients under 65 years. We have examined the role of autologous transplantation in 17 patients with multiple myeloma over 65 years at our centre using a matched pair analysis with younger patients. The median age of this cohort of patients over 65 years was 67 years (65-74) and their outcome and transplant-related morbidity was compared with 17 younger pair mates with a median age of 55 years (31-64). Sixteen patients received high-dose melphalan, and one received busulphan with autologous stem cell rescue. The high-dose therapy was well tolerated in both elderly patients and the matched pairs, with comparable time to recover neutrophils and platelets. Treatmentrelated mortality also did not differ significantly in both the groups. Median overall survival of the elderly patients was 3.59 years similar to 3.01 years of the pair mates (P = 0.92). Autologous stem cell transplantation after high-dose melphalan conditioning was equally well tolerated in groups of patients above and below 65 years. There was no difference in relapse rate, OS and myelotoxicity in both the groups. These findings suggest that advanced age should not be an exclusion criterion from autologous transplant programmes. Bone Marrow Transplantation (2000) 25, 533-539. Keywords: autologous; transplantation; elderly; myeloma Multiple myeloma is a disease of the elderly with a median age of onset of 65 years; the conventional treatment approach in this group of patients is a combination of melphalan and prednisolone.1 According to the Office for National Statistics, the incidence of multiple myeloma in England and Wales is 20.4 per 100 000 males in the 65-69 year age group, rising to 60.7 per 100 000 in the 85 years and over group. In females, the incidence is 14.3 per 100 000 at 65-69 years, rising to 29.9 in the 85 years and over group. 2,3 This rise in age-related incidence justifies reevaluation of current therapies including high-dose chemotherapy and autologous stem cell rescue for more elderly patients.A dose response effect for melphalan has been demonstrated in multiple myeloma. Doses of 140 mg/m 2 without stem cell support, higher doses of melphalan at 200 mg/m 2 with stem cell support and tandem transplants have been associated with increased complete remission (CR) rates, increased event-free survival (EFS) and an increase in overall survival (OS).
4-7A recent randomized trial 7 showed a survival advantage for patients less than 65 years undergoing high-dose melphalan treatment, and this benefit is recognised by health care purchasers now paying for such treatment for people less than 65 years (Geoffrey Carroll, North Thames Purchasing Consortium, personal communication).Recently, transplant-related mortality (TRM) has decreased considerably due to prompt neutrophil recovery with peripheral blood stem cells rescue (PBSC) 8 so that it can now be consi...
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