Article

Autologous stem cell transplantation in multiple myeloma patients <60 vs >/=60 years of age.

Princess Margaret Hospital, Toronto, Ontario, Canada.
Bone Marrow Transplantation (Impact Factor: 3.47). 12/2003; 32(12):1135-43. DOI: 10.1038/sj.bmt.1704288
Source: PubMed

ABSTRACT The role of autologous stem cell transplantation (AuSCT) in older multiple myeloma patients is unclear. Using data from the Autologous Blood and Marrow Transplant Registry, we compared the outcome of 110 patients >/=the age of 60 (median 63; range 60-73) years, undergoing AuSCT with that of 382 patients <60 (median 52; range 30-59) years. The two groups were similar except that older patients had a higher beta(2)-microglobulin level at diagnosis (P=0.016) and fewer had lytic lesions (P=0.007). Day 100 mortality was 6% (95% confidence interval 4-9) and 1-year treatment-related mortality (TRM) was 9% (6-13) in patients <60 years, compared with 5% (2-10) and 8% (4-14), respectively, in patients >/=60 years. The relapse rate, progression-free survival (PFS) and overall survival (OS) in the two groups were also similar. Multivariate analysis of all patients identified only an interval from diagnosis to AuSCT >12 months and the use of two prior chemotherapy regimens within 6 months of AuSCT as adverse prognostic factors. Our results indicate that AuSCT can be safely performed in selected older patients: the best results were observed in patients undergoing AuSCT relatively early in their disease course.

0 Bookmarks
 · 
98 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose Multiple myeloma (MM) is disproportionately diagnosed in older adults; with the aging of the population, the number of older adults diagnosed with MM will increase by nearly 80% in the next two decades. Duration of survival has improved dramatically over the last 20 years, but the improvements in older adults have not been as great as those in younger adults with MM. Methods In this article, we address treatment approaches in older adults who are eligible for and those ineligible for high-dose therapy with autologous stem-cell transplantation as well as supportive care considerations and the potential role for geriatric assessment in facilitating decision making for older adults with MM. Results The evidence from recent studies demonstrates that combinations of novel and conventional antimyeloma agents result in improved response rates and, in some cases, improved progression-free and overall survival. However, some older adults are particularly vulnerable to toxicities of therapy and discontinuation of therapy and, consequently, they have poorer survival. In addition, older adults may prioritize other outcomes of therapy, such as quality of life, over more conventional end points such as disease response and duration of survival. Geriatric assessment can facilitate risk-stratification of older adults at greater risk for adverse events from therapy and aid in personalizing therapy for vulnerable or frail older adults. Conclusion Survival in older adults with MM is improving with novel therapeutics, but efficacy must be balanced with risk of toxicity of therapy and maintenance of quality of life. Novel instruments such as geriatric assessment tools may facilitate these aims. (C) 2014 by American Society of Clinical Oncology
    Journal of Clinical Oncology 07/2014; 32(24). DOI:10.1200/JCO.2014.55.1028 · 17.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Most of our knowledge of the effects of aging on the hematopoietic system comes from studies in animal models. To reveal potential effects of aging on human hematopoietic stem and progenitor cells, in this study CD34(+) cells derived from young (<35 years) and old (>60 years) adult bone marrow were investigated with respect to phenotype and in vitro function. We observed an increased frequency of phenotypically defined stem and progenitor cells upon aging, but no distinct differences with respect to in vitro functional capacity. Since regeneration of peripheral blood counts can be considered to be a functional read-out of hematopoietic stem and progenitor cells, we compared various peripheral blood parameters between younger (≤50 years, n=64) and older patients (≥60 years, n=55) after autologous stem cell transplantation. Patient age did not affect the number of apheresis cycles nor the amount of harvested CD34(+) cells. Parameters for short-term regeneration did not differ significantly between younger and older patients. However, complete recovery of all three blood lineages one year after transplantation was strongly affected by advanced age and occurred in only 29% of older versus 56% of younger patients (p=0.009). Collectively, these data suggest that aging has only limited effects on CD34(+) hematopoietic cells in steady state conditions, but can become important in situations of chemotoxic and replicative stress.
    Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation 03/2014; DOI:10.1016/j.bbmt.2014.03.001 · 3.15 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: High-dose melphalan (200 mg/m(2)) as conditioning regimen followed by autologous stem cell transplantation (ASCT) rescue has been established as a standard treatment for patients with multiple myeloma (MM) younger than 65 years of age. However, the role of ASCT in elderly patients older than 65 years remains controversial in the era of novel agents such as thalidomide, bortezomib, and lenalidomide. The efficacy and feasibility of ASCT have been shown in elderly patients by reducing the dose of melphalan to 100-140 mg/m(2). Although the clinical benefit of reduced-intensity ASCT in elderly patients has not been clearly established in comparison with that of novel agent-based induction therapy, recent studies have demonstrated that sequential strategies of novel agent-based induction therapy and reduced-intensity ASCT followed by consolidation/maintenance with novel agents translate into better outcome in the management of elderly patients. Thus, ASCT could also be a mainstay in the initial treatment of elderly MM patients, and its indication should be evaluated based on performance status and the presence of complications and/or comorbidities of each elderly patient with MM.
    02/2014; 2014:394792. DOI:10.1155/2014/394792
    This article is viewable in ResearchGate's enriched format