title: Autologous stem cell transplantation in patients of 70 years and older with multiple myeloma: Results from a matched pair analysis.
abstract: High-dose therapy and autologous stem cell transplant (HDT) have been shown to prolong survival in multiple myeloma (MM) in randomized trials, but only included patients of 65 years or younger. Given the median age at diagnosis of 66 years, it is important to have a better understanding of the outcome of transplantation in the older patients. We identified 33 patients with MM, who were > or =70 years at the time of their HDT. We matched them to a group of 60 patients, 65 years or younger, (two controls for each patient), based on time to transplant, disease status at transplant, Durie-Salmon stage, labeling index, presence of cytogenetic abnormalities, and presence of circulating plasma cells. The median age of the two groups were 55.6 (range, 37.3-64.9) and 71.7 (range 70-75.8) years at transplant. Although more of the older patients received dose reduced melphalan, the overall response rate was similar (97% vs. 98%) as was the median time to progression (28.5 months vs. 17.8 months, P = 0.7) for the elderly group compared to the younger patients. The median overall survival from transplant was not reached for the elderly patient group compared to 53.2 months for the younger patients, P = 0.7. HDT is feasible in selected patients with multiple myeloma over 70 years. The toxicity of transplant as well as the outcome appears comparable to younger patients. Patients with MM should not be excluded from HDT solely on the basis of their chronological age.
authors.affiliation: Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, Minnesota 55905, USA. kumar.shaji@mayo.edu
authors.forename: Shaji K
authors.initials: SK
authors.lastname: Kumar
authors.forename: David
authors.initials: D
authors.lastname: Dingli
authors.forename: Martha Q
authors.initials: MQ
authors.lastname: Lacy
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Hayman
authors.forename: Francis K
authors.initials: FK
authors.lastname: Buadi
authors.forename: S Vincent
authors.initials: SV
authors.lastname: Rajkumar
authors.forename: Mark R
authors.initials: MR
authors.lastname: Litzow
authors.forename: Morie A
authors.initials: MA
authors.lastname: Gertz
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome