Open AccessOutcomes with autologous stem cell transplant vs. non-transplant therapy in patients 70 years and older with multiple myeloma
Author(s) -
Christopher J. Lemieux,
Lori Muffly,
Andrew R. Rezvani,
Robert Lowsky,
David Iberri,
Juliana Craig,
Matthew J. Frank,
Laura Johnston,
Michaela Liedtke,
Robert S. Negrin,
WenKai Weng,
Everett Meyer,
Judith A. Shizuru,
Parveen Shiraz,
Sally Arai,
David B. Miklos,
Surbhi Sidana
Publication year - 2020
Publication title -
bone marrow transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.609
H-Index - 127
eISSN - 1476-5365
pISSN - 0268-3369
DOI - 10.1038/s41409-020-01026-7
Subject(s) - medicine , multiple myeloma , autologous stem cell transplantation , multivariate analysis , cohort , retrospective cohort study , surgery , progression free survival , oncology , overall survival
We evaluated 79 patients with multiple myeloma (MM) ≥70 years referred to our blood and marrow transplant clinic, within 1 year of diagnosis from 2010 to 2019, for consideration of autologous stem cell transplant (ASCT). Thirty-eight (48%) of 79 patients underwent ASCT. ASCT was not pursued in 41 (52%) patients due to: patient or physician preference in 80% (n = 33) or ineligibility in 20% (n = 8). Baseline characteristics of patients in the two groups were similar. Median PFS from treatment start amongst patients undergoing ASCT (n = 38) vs. not (n = 41) was 41 months vs. 33 months, p = 0.03. There was no difference in OS, with estimated 5-year OS of 73% vs. 83%, respectively (p = 0.86). Day +100 transplant-related mortality (TRM) was 0%. ASCT was an independent favorable prognostic factor for PFS in multivariate analysis, after accounting for HCT-CI score, performance status, hematologic response, and maintenance. Finally, patients ≥70 years undergoing ASCT had similar PFS compared to a contemporaneous institutional cohort of patients <70 years (n = 631) (median PFS from transplant: 36 vs. 47 months, p = 0.25). In this retrospective analysis, ASCT was associated with low TRM and better PFS in fit older adults with MM compared to non-transplant therapy, with comparable benefits as seen in younger patients.