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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.
Abstract:
Multiple myeloma (MM) typically afflicts elderly patients with a median age of 65 years. However, while recently shown to provide superior outcome to standard treatment, high-dose therapy (HDT) has usually been limited to patients up to 65 years. Among 550 patients with MM and a minimum follow-up of 18 months, 49 aged >/=65 years were identified (median age, 67; range, 65 to 76 years). Their outcome was compared with 49 younger pair mates (median, 52; range, 37 to 64 years) selected among the remaining 501 younger patients (<65 years) matched for five previously recognized critical prognostic factors (cytogenetics, beta2-microglobulin, C-reactive protein, albumin, creatinine). Nearly one half had been treated for more than 1 year with standard therapy and about one third had refractory MM. All patients received high-dose melphalan-based therapy; 76% of the younger and 65% of the older group completed a second transplant (P =.3). Sufficient peripheral blood stem cells to support two HDT cycles (CD34 > 5 x 10(6)/kg) were available in 83% of younger and 73% of older patients (P =.2). After HDT, hematopoietic recovery to critical levels of granulocytes (>500/microL) and of platelets (>50,000/microL) proceeded at comparable rates among younger and older subjects with both first and second HDT. The frequency of extramedullary toxicities was comparable. Treatment-related mortality with the first HDT cycle was 2% in younger and 8% among older subjects, whereas no mortality was encountered with the second transplant procedure. Comparing younger/older subjects, median durations of event-free and overall survival were 2.8/1.5 years (P =.2) and 4.8/3.3 years (P =.4). Multivariate analysis showed pretransplant cytogenetics and beta2-microglobulin levels as critical prognostic features for both event-free and overall survival, whereas age was insignificant for both endpoints (P =.2/.8). Thus, age is not a biologically adverse parameter for patients with MM receiving high-dose melphalan-based therapy with peripheral blood stem cell support and, hence, should not constitute an exclusion criterion for participation in what appears to be superior therapy for symptomatic MM.
Insights
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.