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Age is not a prognostic variable with autotransplants for multiple myeloma
D S Siegel1, K R Desikan, J Mehta
1Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences and Arkansas Cancer Research Center, Little Rock 72205, USA.
Blood
|December 24, 1998
Summary
Elderly patients aged 65 and older with multiple myeloma (MM) can safely undergo high-dose therapy (HDT) with melphalan and peripheral blood stem cell support. Age is not a significant factor in outcomes, suggesting it should not exclude patients from this superior MM treatment.
Area of Science:
- Hematology
- Oncology
- Transplant Medicine
Background:
- Multiple myeloma (MM) predominantly affects elderly individuals, with a median age of 65 years.
- High-dose therapy (HDT) offers superior outcomes but has historically been limited to patients under 65.
- The safety and efficacy of HDT in older MM patients remain a critical clinical question.
Purpose of the Study:
- To evaluate the outcomes of high-dose melphalan-based therapy with peripheral blood stem cell support in multiple myeloma patients aged 65 years and older.
- To compare the efficacy and safety of HDT in elderly MM patients versus younger, matched counterparts.
- To determine if age is a significant prognostic factor in patients undergoing HDT for multiple myeloma.
Main Methods:
- Retrospective analysis of 550 multiple myeloma patients with a minimum 18-month follow-up.
- Comparison of 49 patients aged ≥65 years with 49 younger patients (<65 years) matched for critical prognostic factors.
- All patients received high-dose melphalan-based therapy with peripheral blood stem cell support; outcomes, toxicities, and survival were analyzed.
Main Results:
- Hematopoietic recovery and extramedullary toxicities were comparable between younger and older patient groups after HDT.
- Treatment-related mortality was slightly higher in older patients with the first HDT cycle (8% vs. 2%) but comparable with the second.
- Multivariate analysis identified pretransplant cytogenetics and beta2-microglobulin levels as significant prognostic factors, while age was not significant for event-free or overall survival.
Conclusions:
- Age is not a biologically adverse parameter for multiple myeloma patients receiving high-dose melphalan-based therapy with stem cell support.
- High-dose therapy should not be excluded for elderly patients with multiple myeloma based solely on age.
- This approach offers a potentially superior treatment option for symptomatic multiple myeloma, regardless of patient age.