TY - JOUR
T1 - Age no bar
T2 - A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma
AU - Munshi, Pashna N.
AU - Vesole, David
AU - Jurczyszyn, Artur
AU - Zaucha, Jan Maciej
AU - St. Martin, Andrew
AU - Davila, Omar
AU - Agrawal, Vaibhav
AU - Badawy, Sherif M.
AU - Battiwalla, Minoo
AU - Chhabra, Saurabh
AU - Copelan, Edward
AU - Kharfan-Dabaja, Mohamed A.
AU - Farhadfar, Nosha
AU - Ganguly, Siddhartha
AU - Hashmi, Shahrukh
AU - Krem, Maxwell M.
AU - Lazarus, Hillard M.
AU - Malek, Ehsan
AU - Meehan, Kenneth
AU - Murthy, Hemant S.
AU - Nishihori, Taiga
AU - Olin, Rebecca L.
AU - Olsson, Richard F.
AU - Schriber, Jeffrey
AU - Seo, Sachiko
AU - Shah, Gunjan
AU - Solh, Melhem
AU - Tay, Jason
AU - Kumar, Shaji
AU - Qazilbash, Muzaffar H.
AU - Shah, Nina
AU - Hari, Parameswaran N.
AU - D’Souza, Anita
N1 - Publisher Copyright:
© 2020 American Cancer Society
PY - 2020/12/1
Y1 - 2020/12/1
N2 - 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.
AB - 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.
KW - age
KW - geriatric oncology
KW - myeloma
KW - transplantation
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U2 - 10.1002/cncr.33171
DO - 10.1002/cncr.33171
M3 - Article
C2 - 32965680
AN - SCOPUS:85091306660
SN - 0008-543X
VL - 126
SP - 5077
EP - 5087
JO - Cancer
JF - Cancer
IS - 23
ER -