Abstract
Autologous stem cell transplantation (ASCT) is still debatable in treatment of patients over 65 years with multiple myeloma (MM). We performed a retrospective analysis of newly diagnosed MM patients who underwent ASCT between January 2010 and July 2016. A non-transplanted group with similar clinical characteristics, aged 65–70 years old, diagnosed and treated in the same timeline was used for comparison. We analyzed a total of 155 patients, 132 of which underwent ASCT (≤ 65 years, n = 103, median 56 years; > 65 years, n = 29, median 67 years) and 23 non-transplanted (median 68 years). Conditioning consisted of melphalan 200 mg/m2 (MEL200) in younger patients and melphalan 140 mg/m2 (MEL140) in half of elderly patients. Stratifying by age, there were no statistically significant differences concerning transplant-related myelotoxicity and non-hematopoietic toxicity; however, elderly patients conditioned with MEL200 had higher needs of transfusional support and more days of intravenous antibiotics. Those patients also had higher needs of transfusional support, higher grade of mucositis (p = 0.028), and more days of intravenous antibiotics (p = 0.019) than the elderly transplanted with MEL140. Global transplant-related mortality was 3.8%. Survival was not influenced by age. Non-transplanted elderly patients had comparable disease features, and induction response was similar in both groups (before ASCT in the transplanted cohort). Survival of transplanted elderly patients was superior to non-transplanted (OS, 59 months vs 30 months, p = 0.037; EFS, 45 months vs 27 months, p = 0.014). Selected elderly patients when transplanted have similar disease response and survival as younger patients. A higher dose of melphalan has more toxicity, but it is globally a well-tolerated procedure.
Highlights
Multiple myeloma (MM) is mainly a disease of the elderly [1, 2]
Concerning non-hematopoietic toxicity, there were no significant differences in all parameters, namely infection and mucositis
When assessed by the dose of melphalan solely in the elderly group, older patients conditioned by MEL200 seem to have fewer days until neutrophil recovery but with a greater need for transfusion support
Summary
The lengthening of life expectancy is related to an increase in the incidence of oncological diseases, and on the other hand, the improvement of diagnostic acuity and new therapeutic options on MM has led to a longer survival of elderly patients from median 19 months (in 1973) to 6.1 years (in 2004) [1, 3, 4]. Some studies suggest that age at the time of transplant does not have prognostic significance on outcome after ASCT [8, 9], but its safety and efficacy remain uncertain for patients over that age [9,10,11,12,13,14,15,16].
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