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: 3.54). 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
 · 
81 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Hematopoietic cell transplantation (HCT) provides a life-prolonging or potentially curative treatment option for patients with hematologic malignancies. Given the high transplant-related morbidity, these treatment strategies were initially restricted to younger patients, but are increasingly being used in older adults. The incidence of most hematologic malignancies increases with age; with the aging of the population, the number of potential older candidates for HCT increases. Autologous HCT (auto-HCT) in older patients may confer a slightly increased risk of specific toxicities (such as cardiac toxicities and mucositis) and have modestly lower effectiveness (in the case of lymphoma). However, auto-HCT remains a feasible, safe, and effective therapy for selected older adults with multiple myeloma and lymphoma. Similarly, allogeneic transplant (allo-HCT) is a potential therapeutic option for selected older adults, although fewer data exist on allo-HCT in older patients. Based on currently available data, age alone is not the best predictor of toxicity and outcomes; rather, the comorbidities and functional status of the older patient are likely better predictors of toxicity than chronologic age in both the autologous and allogeneic setting. A comprehensive geriatric assessment (CGA) in older adults being considered for either an auto-HCT or allo-HCT may identify additional problems or geriatric syndromes, which may not be detected during the standard pretransplant evaluation. Further research is needed to establish the utility of CGA in predicting toxicity and to evaluate the quality of survival in older adults undergoing HCT.
    Journal of the National Comprehensive Cancer Network: JNCCN 01/2014; 12(1):128-36. · 5.11 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.
    BioMed research international. 01/2014; 2014:394792.
  • [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; · 3.15 Impact Factor