title: Autologous stem cell transplantation is safe and feasible in elderly patients with multiple myeloma.
abstract: Several clinical trials have shown the superiority of autologous stem cell transplantation over conventional dose therapy for patients with multiple myeloma. This treatment, however, is limited to younger patients (<65 years) owing to concerns about toxicity and treatment-related mortality (TRM) in older patients. We treated 26 elderly myeloma patients (>70 years), who received a preparative regimen of melphalan 200 mg/m2 (19 patients), melphalan 180 mg/m2 (six patients) or melphalan 140 mg/m2 (one patient). Twenty-two of the 26 patients were alive after a median follow-up of 25 months (range=8-74). Responses (complete+partial response) were seen in 20 patients (77%), five (19%) of which were complete responses. Median PFS was 24 months, whereas median OS has not been reached. Cumulative incidence of 100-day TRM was 0%. Three-year PFS and OS were 39% (range=16-61) and 65% (range=35-83), respectively. A low serum albumin (<3.5 g/dl) was associated with a shorter PFS (P=0.02). Patients with relapsed disease at transplant, and an interval of >12 months between diagnosis and autotransplant, had a shorter OS (P=0.0004 and 0.04). HDT and autologous transplant is safe and feasible in elderly myeloma patients.
authors.affiliation: Department of Blood and Marrow Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. mqazilba@mdanderson.org
authors.forename: M H
authors.initials: MH
authors.lastname: Qazilbash
authors.forename: R M
authors.initials: RM
authors.lastname: Saliba
authors.forename: C
authors.initials: C
authors.lastname: Hosing
authors.forename: F
authors.initials: F
authors.lastname: Mendoza
authors.forename: S R
authors.initials: SR
authors.lastname: Qureshi
authors.forename: D M
authors.initials: DM
authors.lastname: Weber
authors.forename: M
authors.initials: M
authors.lastname: Wang
authors.forename: T
authors.initials: T
authors.lastname: Flosser
authors.forename: D R
authors.initials: DR
authors.lastname: Couriel
authors.forename: M
authors.initials: M
authors.lastname: De Lima
authors.forename: P
authors.initials: P
authors.lastname: Kebriaei
authors.forename: U
authors.initials: U
authors.lastname: Popat
authors.forename: A M
authors.initials: AM
authors.lastname: Alousi
authors.forename: R E
authors.initials: RE
authors.lastname: Champlin
authors.forename: S A
authors.initials: SA
authors.lastname: Giralt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage*; D009101:Multiple Myeloma / Q000401:mortality / Q000628:therapy*; D019653:Myeloablative Agonists / Q000008:administration & dosage*; D036102:Peripheral Blood Stem Cell Transplantation; D012189:Retrospective Studies; D015996:Survival Rate; D014182:Transplantation, Autologous
chemical_list: D019653:Myeloablative Agonists; D008558:Melphalan