Pashna N Munshi1, David Vesole2, Artur Jurczyszyn3,4, Jan Maciej Zaucha5, Andrew St Martin6, Omar Davila6, Vaibhav Agrawal7, Sherif M Badawy8,9, Minoo Battiwalla10, Saurabh Chhabra6,11, Edward Copelan12, Mohamed A Kharfan-Dabaja13, Nosha Farhadfar14, Siddhartha Ganguly15, Shahrukh Hashmi16,17, Maxwell M Krem18, Hillard M Lazarus19, Ehsan Malek20, Kenneth Meehan21, Hemant S Murthy13, Taiga Nishihori22, Rebecca L Olin23, Richard F Olsson24,25, Jeffrey Schriber26,27, Sachiko Seo28, Gunjan Shah29, Melhem Solh30, Jason Tay31, Shaji Kumar32, Muzaffar H Qazilbash33, Nina Shah23, Parameswaran N Hari6, Anita D'Souza6. 1. MedStar Georgetown University Hospital, Washington, DC. 2. John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey. 3. Medicini Department of Hematology, Jagiellonian University Medical College, Krakow, Poland. 4. Krakow Branch Polish Society of Haematology and Blood Transfusion, Krakow, Poland. 5. Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland. 6. Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin. 7. Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana. 8. Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois. 9. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois. 10. Sarah Cannon Blood Cancer Network, Nashville, Tennessee. 11. Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. 12. Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina. 13. Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida. 14. Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida. 15. Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas. 16. Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. 17. Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 18. Markey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky. 19. University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio. 20. Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio. 21. Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. 22. Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida. 23. University of California at San Francisco, San Francisco, California. 24. Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden. 25. Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden. 26. Cancer Transplant Institute, Virginia G. Piper Cancer Center, Scottsdale, Arizona. 27. Arizona Oncology, Scottsdale, Arizona. 28. Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan. 29. Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York. 30. The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia. 31. Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada. 32. Department of Hematology, Mayo Clinic Rochester, Rochester, Minnesota. 33. The University of Texas M.D. Anderson Cancer Center, Houston, Texas.
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.
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.
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Authors: Joseph E Maakaron; Mei-Jie Zhang; Karen Chen; Sunil Abhyankar; Vijaya Raj Bhatt; Saurabh Chhabra; Najla El Jurdi; Sherif S Farag; Fiona He; Mark Juckett; Marcos de Lima; Navneet Majhail; Marjolein van der Poel; Ayman Saad; Bipin Savani; Celalettin Ustun; Edmund K Waller; Mark Litzow; Partow Kebriaei; Christopher S Hourigan; Wael Saber; Daniel Weisdorf Journal: Bone Marrow Transplant Date: 2022-04-02 Impact factor: 5.174
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