title: High-dose therapy and autologous stem cell transplant in older adults with multiple myeloma.
abstract: Randomized trials showing that high-dose therapy with autologous stem cell transplant (ASCT) improved the overall survival (OS) in multiple myeloma (MM) excluded patients over age 65. To compare the outcomes of older adults with MM who underwent ASCT with non-transplant strategies, we identified 146 patients aged 65-77 with newly diagnosed MM seen in the Washington University School of Medicine from 2000 to 2010. Survival among patients who did (N=62) versus did not (N=84) undergo ASCT was compared using Cox proportional hazards modeling, controlling for comorbidities, Eastern Cooperative Oncology Group performance status (PS) and the propensity to undergo ASCT. Median age was 68 years (range 65-77). PS and comorbidities did not differ significantly between those who did versus those who did not undergo ASCT. Median OS was significantly longer in patients who underwent ASCT than in those who did not (median 56.0 months (95% confidence intervals (CIs) 49.1-65.4) versus 33.1 months (24.3-43.1), P=0.004). Adjusting for PS, comorbidities, Durie-Salmon stage and the propensity to undergo ASCT, ASCT was associated with superior OS (HR for mortality 0.52 (95% CI 0.30-0.91), P=0.02). In a cohort of older adults with MM, undergoing ASCT was associated with a nearly 50% lower mortality, after controlling for PS, comorbidities, stage and the propensity to undergo ASCT.
authors.affiliation: Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: Wildes
authors.affiliation: Rush University Medical College, Chicago, IL, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Finney
authors.affiliation: Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: M
authors.initials: M
authors.lastname: Fiala
authors.affiliation: Division of Biostatistics, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: F
authors.initials: F
authors.lastname: Gao
authors.affiliation: Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: R
authors.initials: R
authors.lastname: Vij
authors.affiliation: Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: K
authors.identifier: 0000000272341715
authors.initials: K
authors.lastname: Stockerl-Goldstein
authors.affiliation: Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: K R
authors.initials: KR
authors.lastname: Carson
authors.affiliation: Mayo Clinic, Scottsdale, AZ, USA.
authors.forename: J
authors.initials: J
authors.lastname: Mikhael
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: G
authors.initials: G
authors.lastname: Colditz
mesh_terms: D000368:Aged; D064592:Autografts; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000401:mortality* / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D033581:Stem Cell Transplantation; D015996:Survival Rate