title: Older patients with myeloma derive similar benefit from autologous transplantation.
abstract: Autologous hematopoietic cell transplantation (AHCT) for plasma cell myeloma is performed less often in people >70 years old than in people ≤70 years old. We analyzed 11,430 AHCT recipients for plasma cell myeloma prospectively reported to the Center for International Blood and Marrow Transplant Research between 2008 and 2011, representing the majority of US AHCT activity during this period. Survival (OS) was compared in 3 cohorts: ages 18 to 59 years (n = 5818), 60 to 69 years (n = 4666), and >70 years (n = 946). Median OS was not reached for any cohort. In multivariate analysis, increasing age was associated with mortality (P = .0006). Myeloma-specific mortality was similar among cohorts at 12%, indicating an age-related effect on nonmyeloma mortality. Analyses were performed in a representative subgroup comparing relapse rate, progression-free survival (PFS), and nonrelapse mortality (NRM). One-year NRM was 0% for age >70 years and 2% for other ages (P = not significant). The three-year relapse rate was 56% in age 18 to 59 years, 61% in age 60 to 69 years, and 63% age >70 (P = not significant). Three-year PFS was similar at 42% in age 18 to 59 years, 38% in age 60 to 69 years, and 33% in age >70 years (P = not significant). Postrelapse survival was significantly worse for the older cohort (P = .03). Older subjects selected for AHCT derived similar antimyeloma benefit without worse NRM, relapse rate, or PFS.
authors.affiliation: Department of Medical Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Manish
authors.initials: M
authors.lastname: Sharma
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin; Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Mei-Jie
authors.initials: MJ
authors.lastname: Zhang
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Zhong
authors.affiliation: Department of Medicine, Karmanos Cancer Institute, Wayne State University, Detroit, Michigan.
authors.forename: Muneer H
authors.initials: MH
authors.lastname: Abidi
authors.affiliation: Banner MD Anderson Cancer Center, Gilbert, Arizona.
authors.forename: Görgün
authors.initials: G
authors.lastname: Akpek
authors.affiliation: Department of Stem Cell Transplantation, University of Hamburg, Hamburg, Germany; MLL Munich Leukemia Laboratory, Munich, Germany.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
authors.affiliation: Bone Marrow Transplant Program, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Natalie S
authors.initials: NS
authors.lastname: Callander
authors.affiliation: Department of Hematology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Angela
authors.initials: A
authors.lastname: Dispenzieri
authors.affiliation: Department of Medicine, South Texas Veterans Health Care System and University of Texas Health Science Center San Antonio, San Antonio, Texas.
authors.forename: César O
authors.initials: CO
authors.lastname: Freytes
authors.affiliation: Department of Medical Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Fung
authors.affiliation: Hematology Research Centre, Division of Experimental Medicine, Department of Medicine, Imperial College London, London, United Kingdom.
authors.forename: Robert Peter
authors.initials: RP
authors.lastname: Gale
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gasparetto
authors.affiliation: Institute of Haematology, Royal Prince Alfred Hospital, Camperdown, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Gibson
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Leona A
authors.initials: LA
authors.lastname: Holmberg
authors.affiliation: Department of Medicine, University of Virginia, Charlottesville, Virginia.
authors.forename: Tamila L
authors.initials: TL
authors.lastname: Kindwall-Keller
authors.affiliation: Department of Medicine, Temple Bone Marrow Transplant Program, Philadelphia, Pennsylvania.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Klumpp
authors.affiliation: Department of Hematology/Oncology, City of Hope National Medical Center, Duarte, California.
authors.forename: Amrita Y
authors.initials: AY
authors.lastname: Krishnan
authors.affiliation: Department of Medicine, Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Landau
authors.affiliation: Department of Medicine, Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, Ohio.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Department of Medicine, Emory University Hospital, Atlanta, Georgia.
authors.forename: Sagar
authors.initials: S
authors.lastname: Lonial
authors.affiliation: Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Angelo
authors.initials: A
authors.lastname: Maiolino
authors.affiliation: University Hospitals Bristol NHS Trust, Bristol, United Kingdom.
authors.forename: David I
authors.initials: DI
authors.lastname: Marks
authors.affiliation: Central Arkansas Veterans Healthcare System, Little Rock, Arkansas; Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
authors.forename: Paulette
authors.initials: P
authors.lastname: Mehta
authors.affiliation: Department of Hematology/Oncology, Mayo Clinic Arizona and Phoenix Children's Hospital, Phoenix, Arizona.
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Mikhael Med
authors.affiliation: Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida.
authors.forename: Taiga
authors.initials: T
authors.lastname: Nishihori
authors.affiliation: Division of Therapeutic Immunology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
authors.forename: Richard
authors.initials: R
authors.lastname: Olsson
authors.affiliation: Department of Hematologic Malignancies Bone Marrow Transplant, UMass Memorial Medical Center, Worcester, Massachusetts.
authors.forename: Muthalagu
authors.initials: M
authors.lastname: Ramanathan
authors.affiliation: Department of Medicine, Blood and Marrow Transplant Program, Mayo Clinic, Jacksonville, Florida.
authors.forename: Vivek
authors.initials: V
authors.lastname: Roy
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Academische Ziekenhuis Maastricht, Maastricht, Netherlands.
authors.forename: Harry C
authors.initials: HC
authors.lastname: Schouten
authors.affiliation: Department of Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: Emma
authors.initials: E
authors.lastname: Scott
authors.affiliation: University of Ottawa, Ottawa, Canada.
authors.forename: Jason
authors.initials: J
authors.lastname: Tay
authors.affiliation: Royal Adelaide Hospital, Adelaide, Australia.
authors.forename: Luen Bik
authors.initials: LB
authors.lastname: To
authors.affiliation: Hackensack University Medical Center, Hackensack, New Jersey.
authors.forename: David H
authors.initials: DH
authors.lastname: Vesole
authors.affiliation: Department of Medicine, Abramson Cancer Center, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania.
authors.forename: Dan T
authors.initials: DT
authors.lastname: Vogl
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: phari@mcw.edu.
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Hari
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy*; D011446:Prospective Studies; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Autologous transplantation; Myeloma; Older patients