Transplant May Be a Valid Treatment Option for Older Patients with Myeloma

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Older patients who underwent ASCT had superior survival compared with nontransplanted older patients, researchers found.
Older patients who underwent ASCT had superior survival compared with nontransplanted older patients, researchers found.

Certain older patients with multiple myeloma could benefit from undergoing autologous stem cell transplantation (ASCT), according to a recent study.These older patients had similar disease response and survival as younger patients undergoing the same type of transplant.

In addition, older patients who underwent ASCT had superior survival compared with nontransplanted older patients, both for overall survival (59 months vs 30 months, respectively; = .037) and event-free survival (45 months vs 27 months, respectively; = .014). 

The retrospective study compared 132 patients with newly diagnosed myeloma (103 patients aged 65 years or younger; 29 patients older than 65 years) who underwent transplant with a group of 23 similar nontransplanted patients aged 65 years to 70 years.

Conditioning was 200 mg/mmelphalan for younger patients and half of the older patients; the other half of older patients had conditioning with 140 mg/m2melphalan. 

Compared with patients aged younger than 65, older patients had no increased transplant-related myelotoxicity and nonhematopoietic toxicity. However, among the half of older patients conditioned with melphalan 200 mg/m2, there was a higher need for transfusional support and more days on intravenous antibiotics. In addition, preconditioning with 200 mg/m2melphalan resulted in significantly increased mucositis (= .028), increased need for transfusional support, and more days on IV antibiotics (P= .019) compared with older patients preconditioned with a lower dose of melphalan. 

According to the researchers, despite the higher rate of complications seen with 200 mg/mmelphalan, the complications were “manageable” with current supportive standard of care. 

“Taking into account that optimal management of multiple myeloma is vital for patient outcome, age should not be considered a major obstacle to transplantation,” the researchers wrote. “Eligibility should be based on biological fitness and comorbidities, ideally through geriatric assessment tools and comorbidity scores to avoid subjectivity, which was also an important limitation when analyzing our elderly patients.”

Reference

  1. Marini C, Maia T, Bergantim R, et al. Real-life data on safety and efficacy of autologous stem cell transplantation in elderly patients with multiple myeloma [published online October 27, 2018]. Ann Hematol.doi: 10.1007/s00277-018-3528-x

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