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. 2020 Dec 1;126(23):5077-5087.
doi: 10.1002/cncr.33171. Epub 2020 Sep 23.

Age no bar: A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma

Pashna N Munshi  1 , David Vesole  2 , Artur Jurczyszyn  3   4 , Jan Maciej Zaucha  5 , Andrew St Martin  6 , Omar Davila  6 , Vaibhav Agrawal  7 , Sherif M Badawy  8   9 , Minoo Battiwalla  10 , Saurabh Chhabra  6   11 , Edward Copelan  12 , Mohamed A Kharfan-Dabaja  13 , Nosha Farhadfar  14 , Siddhartha Ganguly  15 , Shahrukh Hashmi  16   17 , Maxwell M Krem  18 , Hillard M Lazarus  19 , Ehsan Malek  20 , Kenneth Meehan  21 , Hemant S Murthy  13 , Taiga Nishihori  22 , Rebecca L Olin  23 , Richard F Olsson  24   25 , Jeffrey Schriber  26   27 , Sachiko Seo  28 , Gunjan Shah  29 , Melhem Solh  30 , Jason Tay  31 , Shaji Kumar  32 , Muzaffar H Qazilbash  33 , Nina Shah  23 , Parameswaran N Hari  6 , Anita D'Souza  6
Affiliations

Age no bar: A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma

Pashna N Munshi et al. Cancer. .

Erratum in

Abstract

Background: Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults.

Methods: The authors investigated the outcomes of AHCT in patients with MM who were aged ≥70 years. The Center for International Blood and Marrow Transplant Research (CIBMTR) database registered 15,999 patients with MM in the United States within 12 months of diagnosis during 2013 through 2017; a total of 2092 patients were aged ≥70 years. Nonrecurrence mortality (NRM), disease recurrence and/or progression (relapse; REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models with age at transplantation as the main effect. Because of the large sample size, a P value <.01 was considered to be statistically significant a priori.

Results: An increase in AHCT was noted in 2017 (28%) compared with 2013 (15%) among patients aged ≥70 years. Although approximately 82% of patients received melphalan (Mel) at a dose of 200 mg/m2 overall, 58% of the patients aged ≥70 years received Mel at a dose of 140 mg/m2 . On multivariate analysis, patients aged ≥70 years demonstrated no difference with regard to NRM (hazard ratio [HR] 1.3; 99% confidence interval [99% CI], 1-1.7 [P = .06]), REL (HR, 1.03; 99% CI, 0.9-1.1 [P = 0.6]), PFS (HR, 1.06; 99% CI, 1-1.2 [P = 0.2]), and OS (HR, 1.2; 99% CI, 1-1.4 [P = .02]) compared with the reference group (those aged 60-69 years). In patients aged ≥70 years, Mel administered at a dose of 140 mg/m2 was found to be associated with worse outcomes compared with Mel administered at a dose of 200 mg/m2 , including day 100 NRM (1% [95% CI, 1%-2%] vs 0% [95% CI, 0%-1%]; P = .003]), 2-year PFS (64% [95% CI, 60%-67%] vs 69% [95% CI, 66%-73%]; P = .003), and 2-year OS (85% [95% CI, 82%-87%] vs 89% [95% CI, 86%-91%]; P = .01]), likely representing frailty.

Conclusions: The results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups.

Keywords: age; geriatric oncology; myeloma; transplantation.

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Conflict of interest statement

All other authors have no conflicts to declare.

Figures

Figure 1.
Figure 1.
Outcomes in ≥70 year old adults by melphalan dose
Figure 2.
Figure 2.
Overall survival for Mel 200 patients by age groups
See this image and copyright information in PMC

Comment in

  • Age is just a number, the wrong number.
    Bal S, Costa LJ. Bal S, et al. Cancer. 2020 Dec 1;126(23):5014-5016. doi: 10.1002/cncr.33170. Epub 2020 Sep 23. Cancer. 2020. PMID: 32965676 No abstract available.

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