Shah, Gunjan L.
https://orcid.org/0000-0002-9977-0456
Mayo Clinic
Memorial Sloan Kettering Cancer Center
Citations 11
Age no bar: A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma
Munshi, Pashna N. , Vesole, David H. , Martin, Andrew St., Dávila, Omar, Badawy, Sherif M. , Copelan, Edward A. , Kharfan‐Dabaja, Mohamed A. , Farhadfar, Nosha , Ganguly, Siddhartha , Hashmi, Shahrukh K. , Krem, Maxwell M. , Malek, Ehsan , Meehan, Kenneth R., Murthy, Hemant S. , Olin, Rebecca L. , Schriber, Jeffrey, Seo, Sachiko , Shah, Gunjan L. , Solh, Melhem , Tay, Jason , Kumar, Shaji , Qazilbash, Muzaffar H. , Shah, Nina , D’Souza, Anita , Farhadfar, Nosha , Hashmi, Shahrukh K , Malek, Ehsan , Kumar, Shaji K , Qazilbash, Muzaffar H , Shah, Nina , D'Souza, Anita , Murthy, Hemant S , Badawy, Sherif M , Shah, Gunjan L , Jurczyszyn, Artur , Zaucha, Jan Maciej , Agrawal, Vaibhav , Battiwalla, Minoo , Chhabra, Saurabh , Lazarus, Hillard M. , Nishihori, Taiga , Olsson, Richard F. , Hari, Parameswaran
Cancer | September 23, 2020 | Volume: 126 | Issue: 23 | Pages: 5077-5087
BackgroundUpfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults.MethodsThe authors investigated the outcomes of AHCT in patients with MM who were aged ≥70 years. The Center for International Blood and Marrow Transplant Research (CIBMTR) database registered 15,999 patients with MM in the United States within 12 months of diagnosis during 2013 through 2017; a total of 2092 patients were aged ≥70 years. Nonrecurrence mortality (NRM), disease recurrence and/or progression (relapse; REL), progression‐free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models with age at transplantation as the main effect. Because of the large sample size, a P value <.01 was considered to be statistically significant a priori.ResultsAn increase in AHCT was noted in 2017 (28%) compared with 2013 (15%) among patients aged ≥70 years. Although approximately 82% of patients received melphalan (Mel) at a dose of 200 mg/m2 overall, 58% of the patients aged ≥70 years received Mel at a dose of 140 mg/m2. On multivariate analysis, patients aged ≥70 years demonstrated no difference with regard to NRM (hazard ratio [HR] 1.3; 99% confidence interval [99% CI], 1‐1.7 [P = .06]), REL (HR, 1.03; 99% CI, 0.9‐1.1 [P = 0.6]), PFS (HR, 1.06; 99% CI, 1‐1.2 [P = 0.2]), and OS (HR, 1.2; 99% CI, 1‐1.4 [P = .02]) compared with the reference group (those aged 60‐69 years). In patients aged ≥70 years, Mel administered at a dose of 140 mg/m2 was found to be associated with worse outcomes compared with Mel administered at a dose of 200 mg/m2, including day 100 NRM (1% [95% CI, 1%‐2%] vs 0% [95% CI, 0%‐1%]; P = .003]), 2‐year PFS (64% [95% CI, 60%‐67%] vs 69% [95% CI, 66%‐73%]; P = .003), and 2‐year OS (85% [95% CI, 82%‐87%] vs 89% [95% CI, 86%‐91%]; P = .01]), likely representing frailty.ConclusionsThe results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups.