Autologous Stem Cell Transplantation for Elderly Patients with Multiple Myeloma.

Background: Several trials have shown that autologous stem cell transplantation is superior to conventional therapy in terms of complete response (CR) rate, event-free survival (EFS) and overall survival (OS). This treatment, however, is generally limited to patients younger than 65 due to concerns about excessive toxicity and treatment-related mortality (TRM) in older patients. Previous reports have shown that age alone should not exclude patients from high-dose therapy, as long as they fulfill other eligibility criteria. In this report we analyzed the safety and efficacy of high-dose chemotherapy (HDT) and autologous transplant in patients with MM who were ≥ 70 years at the time of autotransplant.

Methods: Twenty-six patients (16 males, 10 females) with a median age of 72 (range 70–79) underwent HDT and an autograft between July 1999 and October 2005. The preparative regimen was melphalan 200 mg/m2 in 19 patients (73%), melphalan 180 mg/m2 in 6 and melphalan140 mg/m2 in 1 patient. Of the 26 patients, 12 were receiving first remission consolidation, 7 had primary refractory disease and 7 had relapsed disease. Clonal cytogenetic abnormalities were present in 5 patients (19%).

Results: Twenty-two of the 26 patients were alive after a median follow up of 15 months (range 2–63). Responses (complete + partial response) were seen in 20 patients (77%), five (19%) of which were complete responses. Median EFS and OS were 19 and 31.6 months, respectively. 100-day TRM was 0%. Median times to absolute neutrophil count of ≥0.5 × 10⁹/l and platelets ≥20 × 10⁹/l were 10 and 10 days, respectively. Three-year EFS and OS were 37% and 49%, respectively. A low serum albumin (<3.5 g/dl) was associated with a shorter EFS (p=0.02), and patients with relapsed disease at transplant had a shorter OS (p=0.002). ISS stage, b2 microglobulin level, lactic dehydrogenase (LDH) level, abnormal cytogenetics, CCI or HCT-CI at the time of transplant did not emerge as significant predictors of PFS or OS in this group of patients.

Conclusions: HDT and autologous transplant is safe and feasible in selected patients ≥70 years of age. The outcome is comparable to younger patients undergoing an autograft, and older patients receiving conventional therapy.