Autologous stem cell transplantation in multiple myeloma patients over age 75.
N Dong, P McKiernan, DSDC Siegel, DH Vesole… - 2018 - ascopubs.org
N Dong, P McKiernan, DSDC Siegel, DH Vesole, SD Rowley, T Andrews, A Ortega…
2018•ascopubs.org8025 Background: Autologous stem cell transplantation (ASCT) has improved the outcome
of patients with Multiple Myeloma (MM) substantially and is now the standard of care.
Patients over the age of 75 years are often denied this procedure due to toxicity concern.
Since 35% of patients with MM fall into this age category, the safety and effectiveness of
ASCT in this patient population needs to be studied. Methods: 604 patients with MM who
received an ASCT at John Theurer Cancer Center of HUMC between 2005-2014 were …
of patients with Multiple Myeloma (MM) substantially and is now the standard of care.
Patients over the age of 75 years are often denied this procedure due to toxicity concern.
Since 35% of patients with MM fall into this age category, the safety and effectiveness of
ASCT in this patient population needs to be studied. Methods: 604 patients with MM who
received an ASCT at John Theurer Cancer Center of HUMC between 2005-2014 were …
8025
Background: Autologous stem cell transplantation (ASCT) has improved the outcome of patients with Multiple Myeloma (MM) substantially and is now the standard of care. Patients over the age of 75 years are often denied this procedure due to toxicity concern. Since 35% of patients with MM fall into this age category, the safety and effectiveness of ASCT in this patient population needs to be studied. Methods: 604 patients with MM who received an ASCT at John Theurer Cancer Center of HUMC between 2005-2014 were evaluated. A total of 44 patients ≥ 75 years of age (range 75-84) and 560 patients younger than 75 at time of ASCT were included. The Kaplan–Meier method was used to compare survival between those two age groups. Results: Features of patients older than 75 were summarized in table 1. Melphalan 200mg/ m2 was our primary conditioning regiment (75% of all patients). MM patients who received ASCT at age 75 or older had similar PFS and OS when compared with younger patients; the 3-year PFS was 52% and 46%, respectively; median PFS was 36.1 months vs 33.7 months, respectively, p = 0.76; the 3-year OS was 84% vs 82%, respectively; median OS was 93.3 months vs 127.8 months, respectively, p = 0.27. Two patients died within 100 days after ASCT. One died from subdural hematoma on day +11 and the other from Staphylococcus aureus sepsis on day +25. Conclusions: MM patients over the age of 75 can have similar outcomes from ASCT compared to the younger population. Elderly patients with MM should not be denied ASCT merely based on age.
Patient features of MM patients who received ASCT at age 75 or older.
N = 44Age, mean (range)76.8 (75-84)Female14 (32%)MobilizationCyclophosphamide-based regiment30 (68%)GCSF14 (32%)Received plerixafor8 (18%)CD34 cells collected (x 10e6/kg), mean (range)12.7 (3.1-27.9)Days of CD34 collection, mean (range)3.7 (2-9)Disease Status at HSCTCR1 (2%)VGPR12 (27%)PR21 (48%)SD6 (14%)PD2 (5%)Unknown2 (5%)Conditioning regimentMelphalan 200mg/ m233 (75%)Melphalan 140mg/m29 (20%)Other2 (5%)Best Response post ASCTStringent CR9 (20%)CR9 (20%)VGPR11 (25%)PR7 (16%)SD2 (5%)PD1 (2%)Unknown5 (11%)
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