The real world effectiveness of hematopoietic transplant among elderly individuals with multiple myeloma Journal Article

Authors: Winn, A. N.; Shah, G. L.; Cohen, J. T.; Lin, P. J.; Parsons, S. K.
Article Title: The real world effectiveness of hematopoietic transplant among elderly individuals with multiple myeloma
Abstract: Background: Hematopoietic stem cell transplant (HSCT) is the preferred treatment for young patients with multiple myeloma (MM), but for older adults there is limited evidence on its effectiveness from clinical trials. Methods: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify individuals age 66 years and older with multiple myeloma (MM) who were diagnosed between 2000 and 2007. We used traditional multivariable analysis, propensity score-based analysis, coarsened exact matching, and an instrumental variable analysis to compare survival for individuals who did or did not receive an hematopoietic stem cell transplant. Survival was measured by Cox proportional hazard models. All statistical tests were two-sided. Results: Patients with MM receiving an HSCT were more likely to be white, married, younger, and have fewer comorbidities. Results from all analytic techniques consistently showed that HSCT statistically significantly improved survival, with hazard ratios (HRs) ranging from 0.531 to 0.608 (traditional multivariable analysis: HR = 0.582, 95% confidence interval [CI] = 0.49 to 0.69; propensity score analysis: HR = 0.572, 95% CI = 0.46 to 0.72; coarsened exact matching: HR = 0.608, 95% CI = 0.49 to 0.76; instrumental variable analysis: HR = 0.531, 95% CI = 0.36 to 0.78, all P values ≤. 001). Conclusions: Overall survival has increased among patients with MM receiving HSCT. This finding was consistent across statistical methods, indicating robustness of our findings. © The Author 2015. Published by Oxford University Press. All rights reserved.
Keywords: cancer survival; treatment outcome; aged; aged, 80 and over; major clinical study; overall survival; mortality; united states; outcome assessment; follow up; multiple myeloma; proportional hazards models; odds ratio; hematopoietic stem cell transplantation; age factors; cancer therapy; age; risk; economics; proportional hazards model; comorbidity; cancer registry; seer program; therapy effect; multivariate analysis; kaplan meier method; quality adjusted life year; cost-benefit analysis; cost benefit analysis; caucasian; quality-adjusted life years; kaplan-meier estimate; propensity score; charlson comorbidity index; very elderly; humans; human; male; female; priority journal; article; married person
Journal Title: JNCI: Journal of the National Cancer Institute
Volume: 107
Issue: 8
ISSN: 0027-8874
Publisher: Oxford University Press  
Date Published: 2015-08-01
Start Page: djv139
Language: English
DOI: 10.1093/jnci/djv139
PUBMED: 26023094
PROVIDER: scopus
PMCID: PMC4554189
Notes: Export Date: 2 September 2015 -- Source: Scopus
Citation Impact
MSK Authors
  1. Gunjan Lalitchandra Shah
    195 Shah