Although autologous stem cell transplantation (ASCT) for multiple myeloma is typically evaluated and used in patients younger than 65 years of age, a real-world study published in the 2017 Hematology, transfusion, and cell therapy indicate High-dose chemotherapy (HDT) followed by ASCT is feasible in some older patients, with outcomes similar to those in younger patients.
“Chronological age alone is not an exclusion criterion for transplantation and should be evaluated together with comorbidities and the patient’s physical condition,” the study authors wrote. “These parameters were measured objectively, primarily to detect frailty and identify patients likely to undergo surgery from ASCT. patients who benefit.”
Blood cells | Image source: Катерина Євтехова – stock.adobe.com
This retrospective study aimed to evaluate the safety and efficacy of ASCT for the treatment of multiple myeloma in patients older than 65 years compared with those younger than 65 years. The authors noted that as the world’s population ages and multiple myeloma diagnoses increase over time, there are questions about the feasibility of ASCT, although treatments such as monoclonal antibodies have become attractive options for older patients with newly diagnosed multiple myeloma. force selection, but population becomes increasingly important.
Data on multiple myeloma patients who underwent ASCT at the Italian Hospital in Buenos Aires, Argentina, between January 2008 and December 2018 were used to evaluate outcomes in older versus younger adults. A total of 221 people participated in the study, and the patients were divided into groups according to age. Group 1 included patients at least 65 years of age (n = 50), and group 2 included patients younger than 65 years of age (n = 171). Advanced disease (defined as International Staging System (ISS) group 3) was more common in group 1 (50%) than in group 2 (29%). Severe comorbidities were also more common in group 1 (28% vs 13%; ask =.023). Overall, the majority of patients (90%) received a proteasome inhibitor before ASCT.
Median length of stay, days before neutrophil and platelet engraftment, and need for life support during ASCT hospitalization were similar between the two groups. A total of 64 patients died after ASCT, with 73% of deaths due to disease progression, and mortality after ASCT was similar between groups 1 and 2 (30% and 29%, respectively). Mortality due to complications within 100 days of ASCT was also similar (4% and 3%, respectively).
Treatment-related mortality in the first 100 days was 2% (95% CI, 0.2%-9.3%) and 2.9% (95% CI, 1.1%-6.3%) in Arms 1 and 2, respectively.ask = .32). There were no events that lasted longer than 100 days and no deaths in patients older than 70 years.
At 100 days after ASCT, the overall response rate was 100% in both groups 1 and 2, and transplantation improved the complete response rate in both groups (44% in group 1 and 37% in group 2; ask < .001). Response to ASCT and prior therapy was associated with better overall survival (OS), but age at transplantation was not found to be associated with OS. Maintenance therapy is associated with better progression-free survival and OS.
“Older patients are more likely to experience treatment-related toxicities,” the authors wrote. “Our analysis found no significant differences in transplant-related safety between the two groups. Although we have not conducted specific toxicity analysis on patients in the two groups, appropriate selection of older patients can effectively reduce toxicity without affecting treatment outcomes.”
The authors note that a validated objective assessment of patient health prior to ASCT is key to optimizing treatment efficacy and ensuring safety. These include the International Myeloma Working Group Frailty Score, the Revised Myeloma Comorbidity Index, and the Mayo Frailty Index. Particularly for ASCT, the revised myeloma comorbidity index and the hematopoietic cell transplantation-specific comorbidity index are most appropriate.
“Based on the reported data, we conclude that HDT-ASCT is a safe and effective procedure in healthy patients, regardless of age at the time of ASCT, with similar results and benefits in older patients as in younger patients, ” the author wrote. “Future prospective randomized trials in older patients are needed to determine the true impact of this treatment and compare it with the results of newer treatment options.”
refer to
Seehaus CM, Schutz N, Brulc E, et al. Autologous stem cell transplantation in patients older than 65 years with multiple myeloma: a real-world study. blood cell transfusion cell therapy. Published online September 5, 2023. doi:10.1016/j.htct.2023.07.012