Feasibility of autologous hematopoietic stem cell transplant in patients aged ≥70 years with multiple myeloma

Abstract

We retrospectively analyzed the outcomes of all consecutive patients with myeloma (n = 84) aged ≥70 years who had received autologous hematopoietic stem cell transplant (auto HCT) between July 1999 and June 2010 at our institution. The median age at auto HCT was 72 years, the median number of prior therapies was 2.5 and the median time from diagnosis to auto HCT was 10.2 months. The conditioning regimen consisted of melphalan at 140 mg/m(2) in 10%, 180 mg/m(2) in 25% and 200 mg/m(2) in 65% of patients. The day-100 non-relapse mortality was 3%. The overall response rate at day 100 was 85% (complete response 18%, very good partial response 12%, partial response 55%). After a median follow-up of 25 months among surviving patients, the estimated progression-free survival and overall survival at 5 years were 27% and 67%, respectively. The incidence of grade II-IV toxicity, response rate and survival were similar across three melphalan dose levels. These results indicate that high-dose melphalan plus auto HCT is safe and feasible for patients with multiple myeloma aged ≥70 years and age alone should not be an exclusion criterion for auto HCT.

Autotransplant with and without induction chemotherapy in older multiple myeloma patients: long-term outcome of a randomized trial

“…These mostly report limited numbers of patients. [18][19][20][21][22][23] Registry data are lacking details of toxicity and outcome but demonstrate improvements in overall survival (OS) over the years. 8,9 Melphalan 200 mg/m 2 (MEL200) represents the standard high-dose regimen for the younger patient population.…”

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

“…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. Recently, the transplant-related mortality in MM patients has decreased to 2-4%, probably due to the improvement of supportive therapies [31]. As a consequence, reduced-intensity ASCT is considered to be a safe and effective therapeutic modality even in MM patients aged 65-75 years in a good performance status without relevant comorbidities.…”

Monoclonal Gammopathy of Undetermined Significance and Multiple Myeloma in Older Adults

“…Several studies have shown that ASCT with dose-reduced chemotherapy can be safe and efficacious in appropriately selected older adults (usually those with limited comorbidities and good functional status), with similar rates of severe toxicity, time until MM progression, and overall survival compared with younger patients. [37][38][39] In particular, fit patients in their early 70s are now routinely offered ASCT with a safe expectation of good results.…”