title: Efficacy and safety of autologous hematopoietic cell transplantation in elderly patients with multiple myeloma: a retrospective national multi-site cohort study.
abstract: We aimed to test the efficacy and toxicity of autologous hematopoietic cell transplant (HCT) in Multiple Myeloma (MM) patients aged ≥65 years compared to patients aged 60-64. Two hundred twenty consecutive patients (age ≥65, n = 87) with MM aged 60 and above, who underwent HCT as part of an upfront MM treatment, at four Israeli centers between 2000 and 2014 were included. A melphalan dose of 200 mg/m2was more frequent in the 60-64 age group vs. the ≥65 age group (77 vs. 57%, p = 0.002). There were no differences between groups in median day of neutrophil engraftment, incidence of infections, grades 3-4 mucositis, cardiovascular events, or non-relapse mortality at 100 days post HCT (4.7, vs. 5%, p = 0.9). A similar rate of improvement in response level was observed (36, vs. 35%, p = 0.87). At 3 years post HCT progression-free survival (PFS) was higher in the 60-64 age group (42 vs. 29%, p = 0.04); however, it was no longer so after adjustment for disease status prior to HCT (p = 0.49). In a Multivariate analysis, melphalan doses and age did not predict PFS. There was no difference in overall survival (OS) between age groups (p = 0.2). We conclude that toxicity profile, response, PFS, and OS of HCT in aged ≥65 patients with myeloma is similar to patients aged 60-64.
authors.affiliation: Department of Hematology, Tel-Aviv Sourasky Medical Center, Institute of Hematology, Weizman St. 6, Tel Aviv, Israel. yaelcoh@tlvmc.gov.il.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. yaelcoh@tlvmc.gov.il.
authors.forename: Yael C
authors.initials: YC
authors.lastname: Cohen
authors.affiliation: Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.|Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Tsila
authors.initials: T
authors.lastname: Zuckerman
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Petah Tikva, Israel.
authors.forename: Moshe
authors.initials: M
authors.lastname: Yeshurun
authors.affiliation: BMT Unit, Sourasky Medical Center, Institute of Hematology, Tel Aviv, Israel.
authors.forename: Galit
authors.initials: G
authors.lastname: Perez
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Petah Tikva, Israel.
authors.forename: Hila
authors.initials: H
authors.lastname: Magen
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Israel
authors.initials: I
authors.lastname: Henig
authors.affiliation: Soroka Medical Center, Hematology Institute, Beer Sheva, Israel.
authors.forename: Itai
authors.initials: I
authors.lastname: Levi
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Petah Tikva, Israel.
authors.forename: Liat
authors.initials: L
authors.lastname: Shargian
authors.affiliation: Department of Hematology, Tel-Aviv Sourasky Medical Center, Institute of Hematology, Weizman St. 6, Tel Aviv, Israel.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Trestman
authors.affiliation: Soroka Medical Center, Hematology Institute, Beer Sheva, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Rouvio
authors.affiliation: Department of Hematology, Tel-Aviv Sourasky Medical Center, Institute of Hematology, Weizman St. 6, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Naparstek
authors.affiliation: Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Eti
authors.initials: E
authors.lastname: Ganon-Elazar
authors.affiliation: Department of Hematology, Tel-Aviv Sourasky Medical Center, Institute of Hematology, Weizman St. 6, Tel Aviv, Israel.|Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Irit
authors.initials: I
authors.lastname: Avivi
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.|BMT Unit, Sourasky Medical Center, Institute of Hematology, Tel Aviv, Israel.
authors.forename: Ron
authors.initials: R
authors.lastname: Ram
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D014182:Transplantation, Autologous / Q000009:adverse effects / Q000401:mortality / Q000639:trends; D016896:Treatment Outcome
keywords: Elderly; HCT; Myeloma