title: Efficacy and safety of high-dose chemotherapy with autologous stem cell transplantation in senior versus younger adults with newly diagnosed multiple myeloma.
abstract: We retrospectively studied 340 fit patients with multiple myeloma (MM) who underwent autologous stem cell transplantation (ASCT). We hypothesized that progression-free survival (PFS) of older patients was non-inferior to that of younger patients after ASCT. Our null hypothesis was that the PFS hazard ratio (HR) for a 5-year increase in age was ≥1.05; the alternative (non-inferiority) hypothesis was that the HR was ≤1. The observed HR was 0.94 (95% confidence interval [CI] 0.86-1.03); since the CI upper bound was <1.05, we reject the null hypothesis and conclude that PFS in older patients was at least as good as in younger patients. We cannot reject an analogous null hypothesis for overall survival (HR 1.06 [95% CI 0.94-1.19]), since the CI upper bound >1.05. Toxicity was similar across ages and transplant-related mortality was minimal. 28% of subjects <65 versus 45% of those ≥65 received maintenance therapy. In summary, ASCT prolongs PFS equally well in older vs. younger adults. Although we cannot exclude maintenance as a confounder, these data support ASCT for fit seniors with MM.
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Li-Wen
authors.initials: LW
authors.lastname: Huang
authors.affiliation: Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA.
authors.forename: Wendi
authors.initials: W
authors.lastname: Bacon
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.
authors.forename: Constance
authors.initials: C
authors.lastname: Cirrincione
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USA.
authors.forename: Bercedis
authors.initials: B
authors.lastname: Peterson
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.|Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA.
authors.forename: Gwynn
authors.initials: G
authors.lastname: Long
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.|Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA.
authors.forename: David
authors.initials: D
authors.lastname: Rizzieri
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.|Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Sullivan
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.|Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Corbet
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.|Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Horwitz
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.|Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA.
authors.forename: Nelson
authors.initials: N
authors.lastname: Chao
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.|Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Gasparetto
authors.affiliation: Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.|Division of Hematological Malignancies and Cellular Therapy, Duke Cancer Institute, Durham, NC, USA.|Division of Hematology and Oncology, University of North Carolina - Chapel Hill Comprehensive Cancer Center, Chapel Hill, NC, USA.
authors.forename: Sascha A
authors.identifier: http://orcid.org/0000-0003-2109-1573
authors.initials: SA
authors.lastname: Tuchman
mesh_terms: D000367:Age Factors; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality / Q000628:therapy; D012189:Retrospective Studies; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods*
keywords: autologous; chemotherapy; elderly; myeloma; senior; transplantation