Is autologous stem cell transplant safe and effective for patients aged 75 or older with multiple myeloma?

The aim of this study was to evaluate the safety and effectiveness of autologous stem cell transplant (ASCT) in patients with multiple myeloma (MM) aged 75 or older. The study found that ASCT was safe and effective for certain patients in this age group.

MM is a type of blood cancer that impacts bone marrow. Therapy for MM can include chemotherapy (CT) which is used to destroy the cancer cells. This CT can also destroy the patient’s healthy bone marrow. An ASCT is also used for the treatment of MM, particularly in younger patients. For an ASCT, healthy blood cells are taken from the patient and transplanted back to replace the bone marrow that was destroyed. Some patients need additional care or therapy after the transplant to ensure the ASCT is effective.

Often, patients who are over 65-70 years old are not considered to be eligible for ASCT. For this reason, there are not a lot of studies that have evaluated ASCT in older patients. It is not clear how safe or effective ASCT is for older patients with MM.

This study evaluated 50 patients with MM aged 75 years or older. All patients had received an ASCT at an average of 6.85 months after diagnosis. Before ASCT, 50% of the patients received reduced conditioning therapy. This means lower doses of medications before transplant to reduce the risk of transplant side effects. Patients included had no additional illnesses and had a high level of ability to function independently. Patients were followed up for an average of 22 months.     

48% of patients had the ASCT as an outpatient procedure without needing hospital admission. Hospital admission was required for 52% of patients for fever and infections, dehydration, abnormal heart rhythm, or the need for nutritional support.

100% of patients responded to treatment. 52% of patients had a complete response (no signs of cancer). The average survival time for all patients was 82 months. The average survival time without worsening of disease was 33 months. 

The study found that ASCT is safe and effective in certain patients aged 75 or older. The authors suggest that age should not be an exclusion criterion for ASCT if the patient is fit and has no limiting medical conditions.

The sample size in this study was very small. Also, the study was not randomized and had no control group for comparison.