Does age impact the use of autologous hematopoietic cell transplantation for multiple myeloma?

This study was carried out to examine the effectiveness of autologous stem cell transplant (ASCT) in the management of older patients with multiple myeloma (MM). The authors concluded that ASCT was an effective consolidation therapy in patients with MM across all age groups. 

MM is a more commonly a cancer of older adults. MM comes from the uncontrolled growth of a type of blood cell called plasma cells. ASCT is an important part of the treatment for patients with MM. During ASCT, the patient first gets high-dose chemotherapy and/or radiotherapy to kill the cancer cells in the bone marrow. Then, the patient receives new, healthy blood-forming stem cells. For ASCT the patient’s own stem cells are removed from his/her bone marrow or peripheral blood before the transplant.

Many older patients are considered unfit to receive an ASCT. However, not many studies have compared the effectiveness and safety of ASCT in patients with MM over the age of 70 to younger patients.

Overall, the records of 15999 patients with MM who received ASCT were analyzed. 2092 of these patients were aged 70 or older when they received an ASCT. The average follow-up of patients was 25 months.

There was no difference in mortality not due to relapse in patients aged 70 or older and other age groups. Relapse rate and survival without MM progression were also similar across all age groups. Patients in the 70 and over age group had an overall survival rate of 86% at 2-years compared to 89% in the 60-69 years group, 90% in the 50-59 years group, 91% in the 40-49 years group, and 94% in the 20-39 years group.

Most patients aged 70 or older (1223) received a reduced dose of melphalan (Alkeran) chemotherapy (140 mg/m²) before ASCT. The other patients received the standard melphalan dose (200 mg/m²). Patients who received a reduced dose had poorer overall survival and survival without disease worsening compared to those who received the standard melphalan dose.

The authors found that the use of ASCT is an effective therapy in patients with MM regardless of age. The authors suggest that age should not be an exclusion criterion for ASCT and full-dose melphalan should be used when possible.

This study was based on information from a database of patients who underwent transplantation. This study was also limited to patients undergoing upfront or immediate ASCT. The follow-up period was also rather short.