Abstract
Background: Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults. Methods: The 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. Results: An 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. Conclusions: The results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 5077-5087 |
| Number of pages | 11 |
| Journal | Cancer |
| Volume | 126 |
| Issue number | 23 |
| DOIs | |
| State | Published - Dec 1 2020 |
Keywords
- age
- geriatric oncology
- myeloma
- transplantation
ASJC Scopus subject areas
- Oncology
- Cancer Research
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Age no bar : A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma. / Munshi, Pashna N.; Vesole, David; Jurczyszyn, Artur; Zaucha, Jan Maciej; St. Martin, Andrew; Davila, Omar; Agrawal, Vaibhav; Badawy, Sherif M.; Battiwalla, Minoo; Chhabra, Saurabh; Copelan, Edward; Kharfan-Dabaja, Mohamed A.; Farhadfar, Nosha; Ganguly, Siddhartha; Hashmi, Shahrukh; Krem, Maxwell M.; Lazarus, Hillard M.; Malek, Ehsan; Meehan, Kenneth; Murthy, Hemant S.; Nishihori, Taiga; Olin, Rebecca L.; Olsson, Richard F.; Schriber, Jeffrey; Seo, Sachiko; Shah, Gunjan; Solh, Melhem; Tay, Jason; Kumar, Shaji; Qazilbash, Muzaffar H.; Shah, Nina; Hari, Parameswaran N.; D’Souza, Anita.
In: Cancer, Vol. 126, No. 23, 01.12.2020, p. 5077-5087.Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Age no bar
T2 - A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma
AU - Munshi, Pashna N.
AU - Vesole, David
AU - Jurczyszyn, Artur
AU - Zaucha, Jan Maciej
AU - St. Martin, Andrew
AU - Davila, Omar
AU - Agrawal, Vaibhav
AU - Badawy, Sherif M.
AU - Battiwalla, Minoo
AU - Chhabra, Saurabh
AU - Copelan, Edward
AU - Kharfan-Dabaja, Mohamed A.
AU - Farhadfar, Nosha
AU - Ganguly, Siddhartha
AU - Hashmi, Shahrukh
AU - Krem, Maxwell M.
AU - Lazarus, Hillard M.
AU - Malek, Ehsan
AU - Meehan, Kenneth
AU - Murthy, Hemant S.
AU - Nishihori, Taiga
AU - Olin, Rebecca L.
AU - Olsson, Richard F.
AU - Schriber, Jeffrey
AU - Seo, Sachiko
AU - Shah, Gunjan
AU - Solh, Melhem
AU - Tay, Jason
AU - Kumar, Shaji
AU - Qazilbash, Muzaffar H.
AU - Shah, Nina
AU - Hari, Parameswaran N.
AU - D’Souza, Anita
N1 - Funding Information: The Center for International Blood and Marrow Transplant Research (CIBMTR) is supported primarily by Public Health Service grant U24CA076518 from the National Cancer Institute (NCI); the National Heart, Lung, and Blood Institute (NHLBI); and the National Institute of Allergy and Infectious Diseases (NIAID); grant U24HL138660 from the NHLBI and NCI; grants OT3HL147741, R21HL140314, K23HL141445, and U01HL128568 from the NHLBI; grants HHSH250201700006C, SC1MC31881‐01‐00, and HHSH250201700007C from the Health Resources and Services Administration; and grants N00014‐18‐1‐2850, N00014‐18‐1‐2888, and N00014‐20‐1‐2705 from the Office of Naval Research. Additional federal support was provided by grants P01CA111412, R01CA152108, R01CA215134, R01CA218285, R01CA231141, R01HL126589, R01AI128775, R01HL129472, R01HL130388, R01HL131731, U01AI069197, and U01AI126612 and the Biomedical Advanced Research and Development Authority (BARDA). Support also was provided by the Be The Match Foundation, Boston Children's Hospital, Dana‐Farber Cancer Institute, the Japan Hematopoietic Cell Transplantation Data Center, St. Baldrick's Foundation, the National Marrow Donor Program, the Medical College of Wisconsin, and from the following commercial entities: AbbVie, Actinium Pharmaceuticals Inc, Adaptive Biotechnologies, Adienne SA, AlloVir Inc, Amgen Inc, Anthem Inc, Astellas Pharma US, AstraZeneca, Atara Biotherapeutics Inc, bluebird bio Inc, Bristol‐Myers Squibb, Celgene Corporation, Chimerix Inc, CSL Behring, CytoSen Therapeutics Inc, Daiichi Sankyo Company Ltd, Gamida Cell Ltd, Genzyme, GlaxoSmithKline, HistoGenetics Inc, Incyte Corporation, Janssen Biotech Inc, Janssen Pharmaceuticals Inc, Janssen/Johnson & Johnson, Jazz Pharmaceuticals Inc, Kiadis Pharma, Kite Pharma, Kyowa Kirin, Legend Biotech, Magenta Therapeutics, Mallinckrodt LLC, Medac GmbH, Merck & Company Inc, Merck Sharp & Dohme Corporation, Mesoblast, Millennium, the Takeda Oncology Corporation, Miltenyi Biotec Inc, Novartis Oncology, Novartis Pharmaceuticals Corporation, Omeros Corporation, OncoImmune Inc, Orca Biosystems Inc, Pfizer Inc, Pharmacyclics LLC, Regeneron Pharmaceuticals Inc, REGiMMUNE Corporation, Sanofi Genzyme, Seattle Genetics, Sobi Inc, Takeda Oncology, Takeda Pharma, Terumo BCT, Viracor Eurofins, and Xenikos BV. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, the Health Resources and Services Administration, or any other agency of the US Government. Funding Information: The Center for International Blood and Marrow Transplant Research (CIBMTR) is supported primarily by Public Health Service grant U24CA076518 from the National Cancer Institute (NCI); the National Heart, Lung, and Blood Institute (NHLBI); and the National Institute of Allergy and Infectious Diseases (NIAID); grant U24HL138660 from the NHLBI and NCI; grants OT3HL147741, R21HL140314, K23HL141445, and U01HL128568 from the NHLBI; grants HHSH250201700006C, SC1MC31881-01-00, and HHSH250201700007C from the Health Resources and Services Administration; and grants N00014-18-1-2850, N00014-18-1-2888, and N00014-20-1-2705 from the Office of Naval Research. Additional federal support was provided by grants P01CA111412, R01CA152108, R01CA215134, R01CA218285, R01CA231141, R01HL126589, R01AI128775, R01HL129472, R01HL130388, R01HL131731, U01AI069197, and U01AI126612 and the Biomedical Advanced Research and Development Authority (BARDA). Support also was provided by the Be The Match Foundation, Boston Children's Hospital, Dana-Farber Cancer Institute, the Japan Hematopoietic Cell Transplantation Data Center, St. Baldrick's Foundation, the National Marrow Donor Program, the Medical College of Wisconsin, and from the following commercial entities: AbbVie, Actinium Pharmaceuticals Inc, Adaptive Biotechnologies, Adienne SA, AlloVir Inc, Amgen Inc, Anthem Inc, Astellas Pharma US, AstraZeneca, Atara Biotherapeutics Inc, bluebird bio Inc, Bristol-Myers Squibb, Celgene Corporation, Chimerix Inc, CSL Behring, CytoSen Therapeutics Inc, Daiichi Sankyo Company Ltd, Gamida Cell Ltd, Genzyme, GlaxoSmithKline, HistoGenetics Inc, Incyte Corporation, Janssen Biotech Inc, Janssen Pharmaceuticals Inc, Janssen/Johnson & Johnson, Jazz Pharmaceuticals Inc, Kiadis Pharma, Kite Pharma, Kyowa Kirin, Legend Biotech, Magenta Therapeutics, Mallinckrodt LLC, Medac GmbH, Merck & Company Inc, Merck Sharp & Dohme Corporation, Mesoblast, Millennium, the Takeda Oncology Corporation, Miltenyi Biotec Inc, Novartis Oncology, Novartis Pharmaceuticals Corporation, Omeros Corporation, OncoImmune Inc, Orca Biosystems Inc, Pfizer Inc, Pharmacyclics LLC, Regeneron Pharmaceuticals Inc, REGiMMUNE Corporation, Sanofi Genzyme, Seattle Genetics, Sobi Inc, Takeda Oncology, Takeda Pharma, Terumo BCT, Viracor Eurofins, and Xenikos BV. The views expressed in this article do not reflect the official policy or position of the National Institutes of Health, the Department of the Navy, the Department of Defense, the Health Resources and Services Administration, or any other agency of the US Government. Pashna N. Munshi has received honoraria from Kite Pharma and Incyte for work performed outside of the current study. Mohamed A. Kharfan-Dabaja has acted as a paid consultant for Daiichi Sankyo and Pharmacyclics for work performed outside of the current study. Siddhartha Ganguly has acted as a paid member of the speakers' bureau for Seattle Genetics and Kite Pharma and as a paid member of the advisory board for Kadmon for work performed outside of the current study. Hillard M. Lazarus has acted as a member of the Data Safety Monitoring Board for Celgene for work performed outside of the current study. Ehsan Malek has received grants from MedPacto Inc and Cumberland; has acted as a paid member of the advisory board for Sanofi; has acted as a paid member of the advisory board and speakers' bureau for Takeda and Celgene; and has acted as a paid member of the speakers' bureau for Amgen and Jansen for work performed outside of the current study. Taiga Nishihori has received research support from Novartis and Karyopharm for work performed outside of the current study. Rebecca L. Olin has received grants from Daiichi Sankyo and Astellas; has received a grant from and acted as a paid consultant for Genentech; has received grants from Pfizer; and has acted as a paid consultant for Amgen and Jazz Pharmaceuticals for work performed outside of the current study. Richard F. Olsson has received personal fees from AstraZeneca for work performed outside of the current study. Gunjan Shah has received clinical trial funding from Janssen and Amgen for work performed outside of the current study. Shaji Kumar has received consulting fees and clinical trial support paid to his institution (no personal payments) from Bristol-Myers Squibb/Celgene, Takeda, AbbVie, Janssen, Adaptive, KITE, Medimmune/AstraZeneca, Merck, Novartis, Sanofi, and Roche; has received grants from Medimmune, TeneoBio, and CARsgen; and has acted as a paid consultant for Oncopeptides for work performed outside of the current study. Nina Shah has received research funding from Celgene, Janssen, bluebird bio, Sutro Biopharma, and TeneoBio; has acted in an advisory role for Genentech, Seattle Genetics, Oncopeptides, Karyopharm, Surface Oncology, Precision Biosciences, GlaxoSmithKline, Nektar, Amgen, Indapta Therapeutics, Sanofi, Bristol-Myers Squibb, and CareDx; and has stock ownership in Indapta Therapeutics. Parameswaran N. Hari has received grants and personal fees from Bristol-Myers Squibb, Takeda, Amgen, Janssen, and Pharmacyclics and personal fees from Karyopharm and Sanofi for work performed outside of the current study. Anita D?Souza has received grants from Takeda, Sanofi, and TeneoBio; grants and personal fees from Prothena; and personal fees from Pfizer and Akcea for work performed outside of the current study. The other authors made no disclosures. We used the CIBMTR database, which captures and prospectively maintains the outcomes of approximately 75% to 80% of transplantations among patients with MM in the United States from 2013 through 2017.14 The CIBMTR is a working group of >500 transplantation centers worldwide that contribute detailed data regarding HCT to a statistical center at the Medical College of Wisconsin. Participating centers are required to report all transplantations consecutively and compliance is monitored by on-site audits. Computerized checks for discrepancies, physician review of submitted data, and on-site audits of participating centers ensure data quality. Data are collected at 2 levels: transplantation essential data (TED) and comprehensive report form (CRF) data. TED forms include disease type, age, sex, pre-HCT disease stage and chemotherapy responsiveness, date of diagnosis, graft type, conditioning regimen, posttransplantation disease progression and survival, development of a new malignancy, and cause of death. All CIBMTR centers contribute to the TED set. More detailed disease information as well as pretransplantation and posttransplantation clinical information are collected for a subset of registered patients selected for CRF data using a weighted randomization scheme. TED-level and CRF-level data are collected before transplantation and 100 days and 6 months after HCT and annually thereafter or until death. Data for the current analysis were retrieved from TED report forms because the intent was to capture all patients registered with the CIBMTR. Observational studies conducted by the CIBMTR are performed in compliance with all applicable federal regulations pertaining to the protection of human research participants. The Medical College of Wisconsin institutional review board approved the current study. We used the CIBMTR database, which captures and prospectively maintains the outcomes of approximately 75% to 80% of transplantations among patients with MM in the United States from 2013 through 2017.14 The CIBMTR is a working group of >500 transplantation centers worldwide that contribute detailed data regarding HCT to a statistical center at the Medical College of Wisconsin. Participating centers are required to report all transplantations consecutively and compliance is monitored by on-site audits. Computerized checks for discrepancies, physician review of submitted data, and on-site audits of participating centers ensure data quality. Data are collected at 2 levels: transplantation essential data (TED) and comprehensive report form (CRF) data. TED forms include disease type, age, sex, pre-HCT disease stage and chemotherapy responsiveness, date of diagnosis, graft type, conditioning regimen, posttransplantation disease progression and survival, development of a new malignancy, and cause of death. All CIBMTR centers contribute to the TED set. More detailed disease information as well as pretransplantation and posttransplantation clinical information are collected for a subset of registered patients selected for CRF data using a weighted randomization scheme. TED-level and CRF-level data are collected before transplantation and 100 days and 6 months after HCT and annually thereafter or until death. Data for the current analysis were retrieved from TED report forms because the intent was to capture all patients registered with the CIBMTR. Observational studies conducted by the CIBMTR are performed in compliance with all applicable federal regulations pertaining to the protection of human research participants. The Medical College of Wisconsin institutional review board approved the current study. Included in the current analysis were consented adult patients (those aged ?18 years) in the United States who were diagnosed with MM and who underwent a single AHCT within 12 months of diagnosis between 2013 and 2017 with peripheral blood hematopoietic cells after melphalan (Mel) conditioning. The TED data set was used in the current study and provided data regarding patient-related (age, sex, race, Karnofsky performance score [KPS], and HCT comorbidity index [HCT-CI]), disease-related (immunoglobulin subtype, International Staging System stage, and cytogenetics), and transplantation-related (time from diagnosis to transplantation, disease status at the time of transplantation, Mel conditioning dose, and year of transplantation) covariates. Data regarding the induction therapy received were available for approximately 13% of the patients selected for the current analysis who were registered in the CRF track. Of these patients, all initially were treated with proteasome inhibitors and/or immunomodulatory drugs, thus extrapolating that patients in the current study all received novel therapy. The primary objective of the current study was to compare NRM in older versus younger patients with MM after AHCT, in which NRM was defined as death from any cause in the absence of REL. Secondary objectives included PFS (defined as the time from transplantation to REL or death from any cause) and OS (defined as the time from transplantation to death from any cause). The primary endpoint of the current study was to assess NRM among different age groups. The secondary endpoint was to assess PFS, OS, and REL among patients in all age groups. Patient characteristics were summarized using descriptive statistics. Cumulative incidences of NRM and REL were calculated accounting for competing risks. Kaplan-Meier estimates were used to calculate the probabilities of PFS and OS. Multivariate analyses of PFS and OS were conducted using the Cox proportional hazards regression analysis to assess the main effect, age at the time of transplantation by decade, adjusting for key patient-related, disease-related, and transplantation-related covariates (sex, race, KPS, HCT-CI, stage of disease at the time of diagnosis, disease status at the time of transplantation, cytogenetics, conditioning Mel dose, time from diagnosis to transplantation, and year of transplantation). Patients aged 60 to 69 years were used as the reference group based on the maximum representation of patients. Because of the very few events noted to occur among patients aged <40 years as well as a small overall number of patients, this group was excluded from the multivariate analysis. Mel dose was studied at 2 levels: the standard 200 mg/m2 dose and the reduced 140 mg/m2 dose. The assumption of proportional hazards for each covariate in the Cox model was tested using time-dependent variables. A stepwise model selection approach was used to identify covariates associated with outcomes. Factors that were statistically significant at the 1% level (P?<.01) were retained in the final model. Hazard ratios (HRs) with 99% confidence intervals (99% CIs) were shown. A lower P value was considered to be statistically significant owing to the large sample size of the population and was decided a priori. A second subset analysis was conducted in patients aged ?70 years (2092 patients) in whom the main effect was the Mel conditioning dose. Other covariates that went into the model included sex, race, KPS, HCT-CI, stage of disease at the time of diagnosis, disease status at the time of transplantation, cytogenetics, conditioning Mel dose, time from diagnosis to transplantation, and year of transplantation. Because of the small sample size, P values <.05 were considered to be statistically significant and HRs with 95% CIs are shown. Statistical analysis was performed using SAS statistical software (version 9.2; SAS Institute Inc, Cary, North Carolina). Funding Information: Pashna N. Munshi has received honoraria from Kite Pharma and Incyte for work performed outside of the current study. Mohamed A. Kharfan‐Dabaja has acted as a paid consultant for Daiichi Sankyo and Pharmacyclics for work performed outside of the current study. Siddhartha Ganguly has acted as a paid member of the speakers' bureau for Seattle Genetics and Kite Pharma and as a paid member of the advisory board for Kadmon for work performed outside of the current study. Hillard M. Lazarus has acted as a member of the Data Safety Monitoring Board for Celgene for work performed outside of the current study. Ehsan Malek has received grants from MedPacto Inc and Cumberland; has acted as a paid member of the advisory board for Sanofi; has acted as a paid member of the advisory board and speakers' bureau for Takeda and Celgene; and has acted as a paid member of the speakers' bureau for Amgen and Jansen for work performed outside of the current study. Taiga Nishihori has received research support from Novartis and Karyopharm for work performed outside of the current study. Rebecca L. Olin has received grants from Daiichi Sankyo and Astellas; has received a grant from and acted as a paid consultant for Genentech; has received grants from Pfizer; and has acted as a paid consultant for Amgen and Jazz Pharmaceuticals for work performed outside of the current study. Richard F. Olsson has received personal fees from AstraZeneca for work performed outside of the current study. Gunjan Shah has received clinical trial funding from Janssen and Amgen for work performed outside of the current study. Shaji Kumar has received consulting fees and clinical trial support paid to his institution (no personal payments) from Bristol‐Myers Squibb/Celgene, Takeda, AbbVie, Janssen, Adaptive, KITE, Medimmune/AstraZeneca, Merck, Novartis, Sanofi, and Roche; has received grants from Medimmune, TeneoBio, and CARsgen; and has acted as a paid consultant for Oncopeptides for work performed outside of the current study. Nina Shah has received research funding from Celgene, Janssen, bluebird bio, Sutro Biopharma, and TeneoBio; has acted in an advisory role for Genentech, Seattle Genetics, Oncopeptides, Karyopharm, Surface Oncology, Precision Biosciences, GlaxoSmithKline, Nektar, Amgen, Indapta Therapeutics, Sanofi, Bristol‐Myers Squibb, and CareDx; and has stock ownership in Indapta Therapeutics. Parameswaran N. Hari has received grants and personal fees from Bristol‐Myers Squibb, Takeda, Amgen, Janssen, and Pharmacyclics and personal fees from Karyopharm and Sanofi for work performed outside of the current study. Anita D’Souza has received grants from Takeda, Sanofi, and TeneoBio; grants and personal fees from Prothena; and personal fees from Pfizer and Akcea for work performed outside of the current study. The other authors made no disclosures. Publisher Copyright: © 2020 American Cancer Society
PY - 2020/12/1
Y1 - 2020/12/1
N2 - Background: Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults. Methods: The 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. Results: An 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. Conclusions: The results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups.
AB - Background: Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults. Methods: The 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. Results: An 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. Conclusions: The results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups.
KW - age
KW - geriatric oncology
KW - myeloma
KW - transplantation
UR - http://www.scopus.com/inward/record.url?scp=85091306660&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85091306660&partnerID=8YFLogxK
U2 - 10.1002/cncr.33171
DO - 10.1002/cncr.33171
M3 - Article
C2 - 32965680
AN - SCOPUS:85091306660
VL - 126
SP - 5077
EP - 5087
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 23
ER -