title: Evaluation of the feasibility and efficacy of autologous stem cell transplantation in elderly patients with multiple myeloma.
abstract: OBJECTIVE
  The feasibility and efficacy of high-dose melphalan (HD-MEL) followed by autologous hematopoietic stem cell transplantation (auto-SCT) in elderly patients with multiple myeloma (MM) are discussed.
  
  
  METHODS
  We retrospectively analyzed and compared the results of 25 elderly patients (aged 65-76 years, elderly group) and 63 control patients (aged 51-64 years, control group). Many patients received a vincristine and doxorubicin combined with dexamethasone (VAD) regimen (elderly group: 92%, control group: 78%) with autologous peripheral blood stem cells being harvested after the administration of chemotherapy with high-dose cyclophosphamide (elderly group: 72%, control group: 87%). Ten elderly patients received MEL at a dose of 100-120 mg/m(2), while 15 patients received MEL at a dose of 180-200 mg/m(2).
  
  
  RESULTS
  Treatment-related deaths occurred in one elderly patient and two younger patients due to infections. The rate of achieving complete response (CR) or very good partial response (VGPR) was 60% in the elderly group and 83% in the control group. Progression-free survival from auto-SCT in the elderly group was similar to that observed in the control group (median 17.1 vs. 20.8 months, p=0.26), with the median overall survival (OS) from auto-SCT being 40.8 months in the former and 72.5 months in the latter group (p=0.07). When calculated from the beginning of induction treatment, the median OS of the elderly group was 47.0 months and the 3-year OS rate was 81%.
  
  
  CONCLUSIONS
  The current study provides evidence for the efficacy of auto-SCT in elderly MM patients. A prospective study of auto-SCT in elderly patients using strict eligibility criteria is required to evaluate the prolongation of survival in the era of novel agents.
authors.affiliation: Department of Hematology/Oncology, Kyushu University Hospital, Japan. muta-t@intmed1.med.kyushu-u.ac.jp
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Muta
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Fujisaki
authors.forename: Yuju
authors.initials: Y
authors.lastname: Ohno
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Kamimura
authors.forename: Koji
authors.initials: K
authors.lastname: Kato
authors.forename: Katsuto
authors.initials: K
authors.lastname: Takenaka
authors.forename: Hiromi
authors.initials: H
authors.lastname: Iwasaki
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Eto
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takamatsu
authors.forename: Takanori
authors.initials: T
authors.lastname: Teshima
authors.forename: Koichi
authors.initials: K
authors.lastname: Akashi
mesh_terms: D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D018572:Disease-Free Survival; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D003561:Cytarabine; D014750:Vincristine; D003907:Dexamethasone