Impact of age and serum creatinine value on outcome after autologous blood stem cell transplantation for patients with multiple myeloma

Morie Gertz, Martha Lacy, Angela Dispenzieri, S. R. Hayman, Shaji K Kumar, N. Leung, D. A. Gastineau

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Abstract

High-dose chemotherapy with stem cell transplantation (SCT) is feasible for elderly patients and patients with renal insufficiency. However, the impact of treatment on this patient population is unclear. We evaluated 678 consecutive patients with multiple myeloma who underwent SCT at Mayo Clinic. The complete response rate, time to progression and overall survival was recorded. Patients were stratified according to age (≤65 or >65 years) and serum creatinine value at the time of transplantation (≤2 or >2mg/dl). Patient age did not have an effect on any outcome measure. Creatinine level did not affect complete response rate and time to progression, but patients with creatinine levels above 2mg/ml had a higher day-100 mortality rate and a shorter overall survival rate. Platelet engraftment was also significantly delayed for patients with renal insufficiency. Selected patients over age 65 years may have outcomes identical to that of younger patients. When compared with patients with creatinine levels less than 2mg/ml, patients with elevated creatinine levels had similar response rates and time to progression, but their overall survival was inferior. Transplantation should be offered to selected patients over age 65 years or selected patients with creatinine elevation.

Original languageEnglish (US)
Pages (from-to)605-611
Number of pages7
JournalBone Marrow Transplantation
Volume39
Issue number10
DOIs
StatePublished - May 2007

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Stem Cell Transplantation
Multiple Myeloma
Blood Cells
Creatinine
Serum
Renal Insufficiency
Transplantation
Survival
Blood Platelets
Survival Rate

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

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AU - Lacy, Martha

AU - Dispenzieri, Angela

AU - Hayman, S. R.

AU - Kumar, Shaji K

AU - Leung, N.

AU - Gastineau, D. A.

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AB - High-dose chemotherapy with stem cell transplantation (SCT) is feasible for elderly patients and patients with renal insufficiency. However, the impact of treatment on this patient population is unclear. We evaluated 678 consecutive patients with multiple myeloma who underwent SCT at Mayo Clinic. The complete response rate, time to progression and overall survival was recorded. Patients were stratified according to age (≤65 or >65 years) and serum creatinine value at the time of transplantation (≤2 or >2mg/dl). Patient age did not have an effect on any outcome measure. Creatinine level did not affect complete response rate and time to progression, but patients with creatinine levels above 2mg/ml had a higher day-100 mortality rate and a shorter overall survival rate. Platelet engraftment was also significantly delayed for patients with renal insufficiency. Selected patients over age 65 years may have outcomes identical to that of younger patients. When compared with patients with creatinine levels less than 2mg/ml, patients with elevated creatinine levels had similar response rates and time to progression, but their overall survival was inferior. Transplantation should be offered to selected patients over age 65 years or selected patients with creatinine elevation.

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