Abstract
Autologous hematopoietic cell transplantation (AHCT) is a standard of care in multiple myeloma (MM) patients aged <65 years. To understand age-related trends in utilisation and outcome of AHCT, we analysed 53 675 MM patients who underwent a first AHCT in 31 European countries between 1991 and 2010. The number of patients undergoing AHCT increased for all age groups (<40, 40–49, 50–59, 60–64, 65–69 and ⩾70 years) throughout the observation period. The highest increase was observed for patients aged ⩾65 years, who accounted for 3% of AHCTs in 1991–1995 and for 18.8% of AHCTs in 2006–2010. Risk factors associated with survival over the entire observation period (P<0.001) were calendar period, remission status at AHCT, gender, disease duration before AHCT and age. Survival improved considerably more in older than in younger patients in recent years. In 2006–2010, median 2- and 5-year post-transplant survival ranged from 85.9 and 61.5% in patients <40 years to 80.2 and 49.7% in those ⩾70 years. All-cause day-100 mortality decreased throughout the observation period to ⩽2.4% for all age groups in 2006–2010. The results of this study demonstrate increased utilisation and safety of AHCT with improved post-transplant survival particularly in elderly MM patients in recent years in Europe.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Buy this article
- Purchase on Springer Link
- Instant access to full article PDF
Prices may be subject to local taxes which are calculated during checkout
Similar content being viewed by others
References
Kyle RA, Rajkumar SV . Epidemiology of the plasma-cell disorders. Best Pract Res Clin Haematol 2007; 20: 637–664.
Parkin DM, Bray F, Ferlay J, Pisani P . Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74–108.
Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC . Multiple myeloma. Lancet 2009; 374: 324–339.
Sirohi B, Powles R . Epidemiology and outcomes research for MGUS, myeloma and amyloidosis. Eur J Cancer 2006; 42: 1671–1683.
McElwain TJ, Powles RL . High-dose intravenous melphalan for plasma-cell leukaemia and myeloma. Lancet 1983; 2: 822–824.
Gore ME, Selby PJ, Viner C, Clark PI, Meldrum M, Millar B et al. Intensive treatment of multiple myeloma and criteria for complete remission. Lancet 1989; 2: 879–882.
Jagannath S, Barlogie B, Dicke K, Alexanian R, Zagars G, Cheson B et al. Autologous bone marrow transplantation in multiple myeloma: identification of prognostic factors. Blood 1990; 76: 1860–1866.
Barlogie B, Alexanian R, Dicke KA, Zagars G, Spitzer G, Jagannath S et al. High-dose chemoradiotherapy and autologous bone marrow transplantation for resistant multiple myeloma. Blood 1987; 70: 869–872.
Barlogie B, Hall R, Zander A, Dicke K, Alexanian R . High-dose melphalan with autologous bone marrow transplantation for multiple myeloma. Blood 1986; 67: 1298–1301.
Fermand JP, Levy Y, Gerota J, Benbunan M, Cosset JM, Castaigne S et al. Treatment of aggressive multiple myeloma by high-dose chemotherapy and total body irradiation followed by blood stem cells autologous graft. Blood 1989; 73: 20–23.
Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med 1996; 335: 91–97.
Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.
Ozaki S, Harada T, Saitoh T, Shimazaki C, Itagaki M, Asaoku H et al. Survival of multiple myeloma patients aged 65-70 years in the era of novel agents and autologous stem cell transplantation. A multicenter retrospective collaborative study of the japanese society of myeloma and the european myeloma network. Acta Haematol 2014; 132: 211–219.
Jantunen E, Kuittinen T, Penttila K, Lehtonen P, Mahlamaki E, Nousiainen T . High-dose melphalan (200 mg/m2) supported by autologous stem cell transplantation is safe and effective in elderly (>or=65 years) myeloma patients: comparison with younger patients treated on the same protocol. Bone Marrow Transplant 2006; 37: 917–922.
Kumar SK, Dingli D, Lacy MQ, Dispenzieri A, Hayman SR, Buadi FK et al. Autologous stem cell transplantation in patients of 70 years and older with multiple myeloma: Results from a matched pair analysis. Am J Hematol 2008; 83: 614–617.
Gay F, Magarotto V, Crippa C, Pescosta N, Guglielmelli T, Cavallo F et al. Bortezomib induction, reduced-intensity transplantation, and lenalidomide consolidation-maintenance for myeloma: updated results. Blood 2013; 122: 1376–1383.
Qazilbash MH, Saliba RM, Hosing C, Mendoza F, Qureshi SR, Weber DM et al. Autologous stem cell transplantation is safe and feasible in elderly patients with multiple myeloma. Bone Marrow Transplant 2007; 39: 279–283.
Bashir Q, Shah N, Parmar S, Wei W, Rondon G, Weber DM et al. Feasibility of autologous hematopoietic stem cell transplant in patients aged >/=70 years with multiple myeloma. Leuk Lymphoma 2012; 53: 118–122.
Badros A, Barlogie B, Siegel E, Morris C, Desikan R, Zangari M et al. Autologous stem cell transplantation in elderly multiple myeloma patients over the age of 70 years. Br J Haematol 2001; 114: 600–607.
Palumbo A, Bringhen S, Petrucci MT, Musto P, Rossini F, Nunzi M et al. Intermediate-dose melphalan improves survival of myeloma patients aged 50 to 70: results of a randomized controlled trial. Blood 2004; 104: 3052–3057.
Merz M, Neben K, Raab MS, Sauer S, Egerer G, Hundemer M et al. Autologous stem cell transplantation for elderly patients with newly diagnosed multiple myeloma in the era of novel agents. Ann Oncol 2014; 25: 189–195.
Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Kumar S, Leung N et al. Impact of age and serum creatinine value on outcome after autologous blood stem cell transplantation for patients with multiple myeloma. Bone Marrow Transplant 2007; 39: 605–611.
Facon T, Mary JY, Hulin C, Benboubker L, Attal M, Pegourie B et al. Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet 2007; 370: 1209–1218.
Blade J, Rosinol L, Cibeira MT, Rovira M, Carreras E . Hematopoietic stem cell transplantation for multiple myeloma beyond 2010. Blood 2010; 115: 3655–3663
Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W, Comenzo RL et al. International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100). Leukemia 2009; 23: 1904–1912.
Moreau P, Avet-Loiseau H, Harousseau JL, Attal M . Current trends in autologous stem-cell transplantation for myeloma in the era of novel therapies. J Clin Oncol 2011; 29: 1898–1906.
Palumbo A, Sezer O, Kyle R, Miguel JS, Orlowski RZ, Moreau P et al. International Myeloma Working Group guidelines for the management of multiple myeloma patients ineligible for standard high-dose chemotherapy with autologous stem cell transplantation. Leukemia 2009; 23: 1716–1730.
Brenner H, Gondos A, Pulte D . Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood 2008; 111: 2521–2526.
Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008; 111: 2516–2520.
Turesson I, Velez R, Kristinsson SY, Landgren O . Patterns of improved survival in patients with multiple myeloma in the twenty-first century: a population-based study. J Clin Oncol 2010; 28: 830–834.
Pulte D, Gondos A, Brenner H . Improvement in survival of older adults with multiple myeloma: results of an updated period analysis of SEER data. Oncologist 2011; 16: 1600–1603.
Schaapveld M, Visser O, Siesling S, Schaar CG, Zweegman S, Vellenga E . Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. Eur J Cancer 2010; 46: 160–169.
Pozzi S, Marcheselli L, Bari A, Liardo EV, Marcheselli R, Luminari S et al. Survival of multiple myeloma patients in the era of novel therapies confirms the improvement in patients younger than 75 years: a population-based analysis. Br J Haematol 2013; 163: 40–46.
Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S et al. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia 2014; 28: 1122–1128.
Crawley C, Iacobelli S, Bjorkstrand B, Apperley JF, Niederwieser D, Gahrton G . Reduced-intensity conditioning for myeloma: lower nonrelapse mortality but higher relapse rates compared with myeloablative conditioning. Blood 2007; 109: 3588–3594.
Blade J, Samson D, Reece D, Apperley J, Bjorkstrand B, Gahrton G et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol 1998; 102: 1115–1123.
Durie BG, Harousseau JL, Miguel JS, Blade J, Barlogie B, Anderson K et al. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467–1473.
McCarthy PL Jr, Hahn T, Hassebroek A, Bredeson C, Gajewski J, Hale G et al. Trends in use of and survival after autologous hematopoietic cell transplantation in North America, 1995-2005: significant improvement in survival for lymphoma and myeloma during a period of increasing recipient age. Biol Blood Marrow Transplant 2013; 19: 1116–1123.
Costa LJ, Zhang MJ, Zhong X, Dispenzieri A, Lonial S, Krishnan A et al. Trends in utilization and outcomes of autologous transplantation as early therapy for multiple myeloma. Biol Blood Marrow Transplant 2013; 19: 1615–1624.
Levine MN, Julian JA . Registries that show efficacy: good, but not good enough. J Clin Oncol 2008; 26: 5316–5319.
Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S et al. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia 2013; 28: 1122–1128.
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Competing interests
HG has been a consultant for Janssen, Celgene, Novartis, Onyx and Millennium, has received honoraria from Janssen, Celgene, Novartis, Onyx, Chugai and Millennium, and has received research funding from Janssen, Celgene, Novartis and Chugai. GM has received remuneration from Janssen and Celgene. PM has been a consultant for and received honoraria from Celgene, Janssen, and Millenium. SS has received honoraria from Celgene and Janssen and research funding from Celgene. PS has received honoraria and research funding from Celgene, Janssen and Onyx. The remaining authors declare no conflict of interest.
Additional information
Author Contributions
HWA designed the research, analysed and interpreted the data and wrote the manuscript. RS analysed the data and commented on the manuscript. JH analysed the data. SS, LG, and NK commented on the research design, interpreted the data, provided patients and commented on the manuscript. HG, AMS, GJM, PM, MA, GM, NR, MB, GC and PS interpreted the data, provided patients and commented on the manuscript.
Rights and permissions
About this article
Cite this article
Auner, H., Szydlo, R., Hoek, J. et al. Trends in autologous hematopoietic cell transplantation for multiple myeloma in Europe: increased use and improved outcomes in elderly patients in recent years. Bone Marrow Transplant 50, 209–215 (2015). https://doi.org/10.1038/bmt.2014.255
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/bmt.2014.255
This article is cited by
-
Prospective Association of Psychological Distress and Sexual Quality of Life Among Hematopoietic Stem Cell Transplant Survivors
Journal of Clinical Psychology in Medical Settings (2024)
-
Global disparities in patients with multiple myeloma: a rapid evidence assessment
Blood Cancer Journal (2023)
-
The limited use of autologous hematopoietic stem cell transplant for fit older patients with multiple myeloma in India: a retrospective analysis
Journal of the Egyptian National Cancer Institute (2022)
-
Autologous stem cell transplantation for multiple myeloma patients aged ≥ 75 treated with novel agents
Bone Marrow Transplantation (2021)
-
Outcomes with autologous stem cell transplant vs. non-transplant therapy in patients 70 years and older with multiple myeloma
Bone Marrow Transplantation (2021)