Age is not a prognostic variable with autotransplants for multiple myeloma.

Myeloma and Transplantation Research Center, University of Arkansas for Medical Sciences and Arkansas Cancer Research Center, Little Rock 72205, USA.
Blood (Impact Factor: 9.78). 02/1999; 93(1):51-4.
Source: PubMed

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.

  • [Show abstract] [Hide abstract]
    ABSTRACT: The treatment of multiple myeloma (MM) has dramatically changed in the last decade due to the introduction of the immunomodulatory drugs (IMIDs) and proteasome inhibitors, otherwise known as the novel agents. Prior to the advent of the novel agents, the gold standard of treatment had been high-dose chemotherapy with autologous stem cell transplantation (HDT/ASCT) for eligible candidates. Given the remarkable activity of the novel agents, and the significant morbidity of HDT/ASCT, the role of stem cell transplantation has now come into question. In this review, we explore the benefits and drawbacks to HDT/ASCT in the era of the novel therapies.
    Current Hematologic Malignancy Reports 08/2014; 9(4). DOI:10.1007/s11899-014-0230-5
  • [Show abstract] [Hide abstract]
    ABSTRACT: An estimated 22,350 patients had multiple myeloma diagnosed in 2013, representing 1.3% of all new cancers; 10,710 deaths are projected, representing 1.8% of cancer deaths. Approximately 0.7% of US men and women will have a myeloma diagnosis in their lifetime, and with advances in therapy, 77,600 US patients are living with myeloma. The 5-year survival rate was 25.6% in 1989 and was 44.9% in 2005. The median age at diagnosis is 69 years, with 62.4% of patients aged 65 or older at diagnosis. Median age at death is 75 years. The rate of new myeloma cases has been rising 0.7% per year during the past decade. The most common indication for autologous stem cell transplantation in the United States is multiple myeloma, and this paper is designed to provide the specifics of organizing a transplant program for multiple myeloma. We review the data justifying use of stem cell transplantation as initial management in myeloma patients. We provide selection criteria that minimize the risks of transplantation. Specific guidelines on mobilization and supportive care through the transplant course, as done at Mayo Clinic, are given. A review of the data on tandem vs sequential autologous transplants is provided.
    Blood 06/2014; DOI:10.1182/blood-2014-03-544759 · 9.78 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Autologous hematopoietic cell transplant (AHCT) for plasma cell myeloma (PCM) is performed less often in >70 year olds. We analyzed 11,430 AHCT recipients for PCM prospectively reported to the CIBMTR between 2008 and 2011 representing the majority of US AHCT activity during this period. Survival (OS) was compared in 3 cohorts; ages 18-59 years (N=5818), 60-69 years (N= 4666) and >70 years (N=946). Median OS was not reached for any cohort. In multivariate analysis, increasing age was associated with mortality (p=0.0006). Myeloma specific mortality was similar at 12% indicating age related effect on non-myeloma mortality. Analyses were performed in a representative subgroup comparing relapse rate (RR), progression free survival (PFS) and non-relapse mortality (NRM). 1-year NRM was 0% for age >70 years and 2% for other ages (p = NS). 3-year RR were 56% in age 18-59 years, 61% in age 60-69 years and 63% age >70 (p = NS). 3 year PFS was similar at 42% in age 18-59 years, 38% in age 60-69 years, and 33% in age >70 years (p=NS). Post-relapse survival (PRS) was significantly worse for the older cohort (p=0.03). Older subjects selected for AHCT derived similar anti-myeloma benefit without worse NRM, RR or PFS.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 07/2014; DOI:10.1016/j.bbmt.2014.07.013 · 3.15 Impact Factor