title: In-Hospital Mortality and Post-Transplantation Complications in Elderly Multiple Myeloma Patients Undergoing Autologous Hematopoietic Stem Cell Transplantation: A Population-Based Study.
abstract: Autologous hematopoietic stem cell transplantation (auto-HSCT) has improved survival in patients with multiple myeloma (MM) and is increasingly used in elderly patients. The aim of this study was to characterize and compare in-hospital complications and mortality after auto-HSCT in younger (< age 65) versus elderly (> age 65) MM patients utilizing the Nationwide Inpatient Sample. Over a 3-year period (2008 to 2010), 2209 patients with MM were admitted to US hospitals for auto-HSCT. The median age was 59 years, with 1650 patients (74.7%) younger than age 65 and 559 patients (25.3%) 65 or older. Overall, in-hospital mortality in MM patients after auto-HSCT was rare (1.5%) and there was no significant difference in mortality between elderly and younger patients. Elderly patients did have a significantly increased mean length of stay (18.6 days + 10.8 days [SD] versus 16.8 days + 7.2 days [SD], P < .001) and mean total hospital charges ($161,117 + $105,008 [SD] versus $151,192 + $78,342 [SD] , P = .018) compared with younger patients. Elderly patients were significantly more likely than younger patients to develop major in-hospital post-transplantation complications such as severe sepsis (odds ratio [OR], 2.70; 95% confidence interval [CI], 1.40 to 5.21; P = .003), septic shock (OR, 3.10; 95% CI, 1.43 to 6.71; P = .004), pneumonia (OR, 1.62; 95% CI, 1.06 to 2.46; P = .024), acute respiratory failure (OR, 3.44; 95% CI, 1.70 to 6.96; P = .001), endotracheal intubation requiring prolonged mechanical ventilation (OR, 2.19; 95% CI, 1.06 to 4.55; P = .035), acute renal failure (OR, 2.14; 95% CI, 1.38 to 3.33; P = .001), and cardiac arrhythmias (OR, 2.06; 95% CI, 1.52 to 2.79; P <.001). These data may help guide informed consent discussions and provide a focus for future studies to reduce treatment-related morbidity in elderly MM patients undergoing auto-HSCT.
authors.affiliation: Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey. Electronic address: gromkola@njms.rutgers.edu.
authors.forename: Larysa
authors.initials: L
authors.lastname: Sanchez
authors.affiliation: Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Michael
authors.initials: M
authors.lastname: Sylvester
authors.affiliation: Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Parrondo
authors.affiliation: Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Veronica
authors.initials: V
authors.lastname: Mariotti
authors.affiliation: Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Internal Medicine, Rutgers New Jersey Medical School, Newark, New Jersey; Section of Hematology-Oncology, VA New Jersey Health Care System, East Orange, New Jersey.
authors.forename: Victor T
authors.initials: VT
authors.lastname: Chang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality; D019172:Transplantation Conditioning / Q000009:adverse effects* / Q000379:methods; D014182:Transplantation, Autologous / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult
keywords: Autologous hematopoietic stem cell transplantation; Elderly; Multiple myeloma; Post-transplantation complications