Age no bar: A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma
Pashna N. Munshi, David H. Vesole, Artur Jurczyszyn, Jan Maciej Zaucha, Andrew St. Martin, Omar Dávila, Vaibhav Agrawal, Sherif M. Badawy, Minoo Battiwalla, Saurabh Chhabra, Edward A. Copelan, Mohamed A. Kharfan‐Dabaja, Nosha Farhadfar, Siddhartha Ganguly, Shahrukh K. Hashmi, Maxwell M. Krem, Hillard M. Lazarus, Ehsan Malek, Kenneth R. Meehan, Hemant S. Murthy, Taiga Nishihori, Rebecca L. Olin, Richard F. Olsson, Jeffrey Schriber, Sachiko Seo, Gunjan L. Shah, Melhem Solh, Jason Tay, Shaji Kumar, Muzaffar H. Qazilbash, Nina Shah, Parameswaran Hari, Anita D’Souza
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/m 2 overall, 58% of the patients aged ≥70 years received Mel at a dose of 140 mg/m 2 . 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/m 2 was found to be associated with worse outcomes compared with Mel administered at a dose of 200 mg/m 2 , 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.