TY - JOUR
T1 - Outcomes of upfront autologous hematopoietic cell transplantation in patients with multiple myeloma who are 75 years old or older
AU - Munshi, Pashna N.
AU - Vesole, David H.
AU - St. Martin, Andrew
AU - Davila, Omar
AU - Kumar, Shaji
AU - Qazilbash, Muzaffar
AU - Shah, Nina
AU - Hari, Parameswaran N.
AU - D’Souza, Anita
N1 - Funding Information:
Pasha N. Munshi reports honoraria from KITE and Incyte for participating in speakers' bureaus (which is not relevant to this work). Nina Shah reports grants from Celgene/BMS, Janssen, bluebird bio, Sutro Biopharma, Teneobio, Poseida, Nektar and from GSK, Amgen, Indapta Therapeutics, Sanofi, CareDx, Kite, Karyopharm, and Oncopeptides (which is not relevant to this work). Parameswaran N. Hari reports grants and personal fees from BMS, Takeda, Amgen, Sanofi, and Janssen (which is not relevant to this work). Shaji Kumar reports grants from BMS/Celgene, Takeda, AbbVie, Roche, Janssen, Medimmune, Tenebio, and Carsgen and personal fees from Oncopeptides (which is not relevant to this work). Muzaffar Qazilbash reports funding from Janssen, Bioline, Angiocrine, and Bioclinica while conducting this study. Anita D’Souza reports grants from Sanofi, Takeda, and Tenebio and fees from Akcea, Pfizer, and Janssen (which is not relevant to this work). David H. Vesole reports honoraria from Amgen, Calgene/BMS, Janssen, Takeda, and Glaxo Smith/Kline for participating in speakers' bureau and stock from Amgen and Takeda. The other authors made no disclosures.
Funding Information:
The Center for International Blood and Marrow Transplant Research is supported primarily by Public Health Service U24CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases, U24HL138660 from NHLBI and NCI, OT3HL147741 and U01HL128568 from the NHLBI, HHSH250201700006C and HHSH250201700007C from the Health Resources and Services Administration, and N00014‐20‐1‐2705 and N00014‐20‐1‐2832 from the Office of Naval Research. Additional federal support is provided by P01CA111412, R01CA152108, R01CA215134, R01CA218285, R01CA231141, R01AI128775, R01HL126589, R01HL129472, R01HL130388, R01HL131731, U01AI069197, U01AI126612, UG1HL06924, and BARDA. Support is also provided by Be the Match Foundation, Boston Children's Hospital, Dana‐Farber, St. Baldrick's Foundation, Stanford University, the Medical College of Wisconsin, the National Marrow Donor Program, and the following commercial entities: Actinium Pharmaceuticals, Inc, Adienne SA, Allovir, Inc, Amgen, Inc, Angiocrine Bioscience, Astellas Pharma US, bluebird bio, Inc, Bristol‐Myers Squibb Co, Celgene Corp, CSL Behring, CytoSen Therapeutics, Inc, Daiichi Sankyo Co, Ltd, ExcellThera, Fate Therapeutics, Gamida‐Cell, Ltd, Genentech Inc, Incyte Corp, Janssen/Johnson & Johnson, Jazz Pharmaceuticals, Inc, Kiadis Pharma, Kite, a Gilead Company, Kyowa Kirin, Legend Biotech, Magenta Therapeutics, Merck Sharp & Dohme Corp, Millennium, the Takeda Oncology Co, Miltenyi Biotec, Inc, Novartis Pharmaceuticals Corp, Omeros Corp, Oncoimmune, Inc, Orca Biosystems, Inc, Pfizer, Inc, Pharmacyclics, LLC, Sanofi Genzyme, Stemcyte, Takeda Pharma, Vor Biopharma, and Xenikos BV.
Funding Information:
The Center for International Blood and Marrow Transplant Research is supported primarily by Public Health Service U24CA076518 from the National Cancer Institute (NCI), the National Heart, Lung and Blood Institute (NHLBI) and the National Institute of Allergy and Infectious Diseases, U24HL138660 from NHLBI and NCI, OT3HL147741 and U01HL128568 from the NHLBI, HHSH250201700006C and HHSH250201700007C from the Health Resources and Services Administration, and N00014-20-1-2705 and N00014-20-1-2832 from the Office of Naval Research. Additional federal support is provided by P01CA111412, R01CA152108, R01CA215134, R01CA218285, R01CA231141, R01AI128775, R01HL126589, R01HL129472, R01HL130388, R01HL131731, U01AI069197, U01AI126612, UG1HL06924, and BARDA. Support is also provided by Be the Match Foundation, Boston Children's Hospital, Dana-Farber, St. Baldrick's Foundation, Stanford University, the Medical College of Wisconsin, the National Marrow Donor Program, and the following commercial entities: Actinium Pharmaceuticals, Inc, Adienne SA, Allovir, Inc, Amgen, Inc, Angiocrine Bioscience, Astellas Pharma US, bluebird bio, Inc, Bristol-Myers Squibb Co, Celgene Corp, CSL Behring, CytoSen Therapeutics, Inc, Daiichi Sankyo Co, Ltd, ExcellThera, Fate Therapeutics, Gamida-Cell, Ltd, Genentech Inc, Incyte Corp, Janssen/Johnson & Johnson, Jazz Pharmaceuticals, Inc, Kiadis Pharma, Kite, a Gilead Company, Kyowa Kirin, Legend Biotech, Magenta Therapeutics, Merck Sharp & Dohme Corp, Millennium, the Takeda Oncology Co, Miltenyi Biotec, Inc, Novartis Pharmaceuticals Corp, Omeros Corp, Oncoimmune, Inc, Orca Biosystems, Inc, Pfizer, Inc, Pharmacyclics, LLC, Sanofi Genzyme, Stemcyte, Takeda Pharma, Vor Biopharma, and Xenikos BV.
Publisher Copyright:
© 2021 American Cancer Society
PY - 2021/11/15
Y1 - 2021/11/15
N2 - Background: Consolidative autologous hematopoietic stem cell transplantation (AHCT) is commonly used for patients with multiple myeloma (MM). We studied AHCT use and outcomes in patients with MM ≥75 years old. Methods: Patients with MM ≥75 years old receiving AHCT between 2013 and 2017 in the United States were identified using the Center for International Blood and Marrow Transplant Research database. Relapse and/or progression (REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models. Covariates used were age, sex, Karnofsky performance score (KPS), HCT-comorbidity index (HCT-CI), International Staging System and/or Durie-Salmon stage, high-risk cytogenetics, melphalan dose, and disease status at and 1 year after transplant. AHCT utilization rate using the Surveillance, Epidemiology, and End Results database was used to estimate specific incidence among ≥75 years old by race and gender. Results: Of 360 patients, 63% were male, 84% were White, 56% had KPS <90, and 57% had HCT-CI ≥3. The 100-day transplant-related mortality was 1% (0%-2%) with a 2-year REL rate of 27% (95% confidence interval [CI], 22%-33%), PFS of 66% (95% CI, 60%-72%), and OS of 83% (95% CI, 78%-87%). On multivariate analysis, only high-risk cytogenetics was associated with REL risk and decreased PFS. In White males, transplant utilization rate was 5.2%-5.8% compared to 3.5%-4.0% in African American males (P =.02). There was 3.37-3.79% transplant utilization in White females compared to 1.88-2.12% in African American females (P <.01). Conclusions: The use of AHCT was associated with excellent 2-year outcomes in this selected MM population ≥75 years old. Transplant utilization for patients ≥75 years old remains low with significant racial and gender disparities.
AB - Background: Consolidative autologous hematopoietic stem cell transplantation (AHCT) is commonly used for patients with multiple myeloma (MM). We studied AHCT use and outcomes in patients with MM ≥75 years old. Methods: Patients with MM ≥75 years old receiving AHCT between 2013 and 2017 in the United States were identified using the Center for International Blood and Marrow Transplant Research database. Relapse and/or progression (REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models. Covariates used were age, sex, Karnofsky performance score (KPS), HCT-comorbidity index (HCT-CI), International Staging System and/or Durie-Salmon stage, high-risk cytogenetics, melphalan dose, and disease status at and 1 year after transplant. AHCT utilization rate using the Surveillance, Epidemiology, and End Results database was used to estimate specific incidence among ≥75 years old by race and gender. Results: Of 360 patients, 63% were male, 84% were White, 56% had KPS <90, and 57% had HCT-CI ≥3. The 100-day transplant-related mortality was 1% (0%-2%) with a 2-year REL rate of 27% (95% confidence interval [CI], 22%-33%), PFS of 66% (95% CI, 60%-72%), and OS of 83% (95% CI, 78%-87%). On multivariate analysis, only high-risk cytogenetics was associated with REL risk and decreased PFS. In White males, transplant utilization rate was 5.2%-5.8% compared to 3.5%-4.0% in African American males (P =.02). There was 3.37-3.79% transplant utilization in White females compared to 1.88-2.12% in African American females (P <.01). Conclusions: The use of AHCT was associated with excellent 2-year outcomes in this selected MM population ≥75 years old. Transplant utilization for patients ≥75 years old remains low with significant racial and gender disparities.
KW - elderly
KW - hematopoietic
KW - myeloma
KW - transplantation
KW - utilization
UR - http://www.scopus.com/inward/record.url?scp=85112102705&partnerID=8YFLogxK
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U2 - 10.1002/cncr.33831
DO - 10.1002/cncr.33831
M3 - Article
C2 - 34374445
AN - SCOPUS:85112102705
VL - 127
SP - 4233
EP - 4239
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 22
ER -