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

Authors: Munshi, P. N.; Vesole, D.; Jurczyszyn, A.; Zaucha, J. M.; St. Martin, A.; Davila, O.; Agrawal, V.; Badawy, S. M.; Battiwalla, M.; Chhabra, S.; Copelan, E.; Kharfan-Dabaja, M. A.; Farhadfar, N.; Ganguly, S.; Hashmi, S.; Krem, M. M.; Lazarus, H. M.; Malek, E.; Meehan, K.; Murthy, H. S.; Nishihori, T.; Olin, R. L.; Olsson, R. F.; Schriber, J.; Seo, S.; Shah, G.; Solh, M.; Tay, J.; Kumar, S.; Qazilbash, M. H.; Shah, N.; Hari, P. N.; D’Souza, A.
Article Title: Age no bar: A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma
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. © 2020 American Cancer Society
Keywords: transplantation; age; myeloma; geriatric oncology
Journal Title: Cancer
Volume: 126
Issue: 23
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2020-12-01
Start Page: 5077
End Page: 5087
Language: English
DOI: 10.1002/cncr.33171
PUBMED: 32965680
PROVIDER: scopus
PMCID: PMC8063213
Notes: Article -- Export Date: 1 December 2020 -- Source: Scopus
Citation Impact
MSK Authors
  1. Gunjan Lalitchandra Shah
    200 Shah