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Plasma Cell Disorders

High-dose therapy and autologous stem cell transplant in older adults with multiple myeloma

Bone Marrow Transplantation volume 50, pages 1075–1082 (2015)Cite this article

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Abstract

Randomized trials showing that high-dose therapy with autologous stem cell transplant (ASCT) improved the overall survival (OS) in multiple myeloma (MM) excluded patients over age 65. To compare the outcomes of older adults with MM who underwent ASCT with non-transplant strategies, we identified 146 patients aged 65–77 with newly diagnosed MM seen in the Washington University School of Medicine from 2000 to 2010. Survival among patients who did (N=62) versus did not (N=84) undergo ASCT was compared using Cox proportional hazards modeling, controlling for comorbidities, Eastern Cooperative Oncology Group performance status (PS) and the propensity to undergo ASCT. Median age was 68 years (range 65–77). PS and comorbidities did not differ significantly between those who did versus those who did not undergo ASCT. Median OS was significantly longer in patients who underwent ASCT than in those who did not (median 56.0 months (95% confidence intervals (CIs) 49.1–65.4) versus 33.1 months (24.3–43.1), P=0.004). Adjusting for PS, comorbidities, Durie–Salmon stage and the propensity to undergo ASCT, ASCT was associated with superior OS (HR for mortality 0.52 (95% CI 0.30–0.91), P=0.02). In a cohort of older adults with MM, undergoing ASCT was associated with a nearly 50% lower mortality, after controlling for PS, comorbidities, stage and the propensity to undergo ASCT.

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Acknowledgements

This publication was made possible by the Grant nos KM1CA156708 and K12CA167540 through the National Cancer Institute (NCI) at the National Institutes of Health (NIH) and Grant nos UL1 TR000448 through the Clinical and Translational Science Award (CTSA) program of the National Center for Advancing Translational Sciences (NCATS) at the National Institutes of Health. We acknowledge the support of the Biostatistics Core, Siteman Comprehensive Cancer Center and NCI Cancer Center Support Grant P30 CA091842.

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Authors and Affiliations

  1. Department of Medicine, Division of Medical Oncology, Washington University School of Medicine, St Louis, MO, USA

    T M Wildes, M Fiala, R Vij, K Stockerl-Goldstein & K R Carson

  2. Rush University Medical College, Chicago, IL, USA

    J D Finney

  3. Division of Biostatistics, Washington University School of Medicine, St Louis, MO, USA

    F Gao

  4. Mayo Clinic, Scottsdale, AZ, USA

    J Mikhael

  5. Department of Surgery, Washington University School of Medicine, St Louis, MO, USA

    G Colditz

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  1. T M Wildes
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Correspondence to T M Wildes.

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Wildes, T., Finney, J., Fiala, M. et al. High-dose therapy and autologous stem cell transplant in older adults with multiple myeloma. Bone Marrow Transplant 50, 1075–1082 (2015). https://doi.org/10.1038/bmt.2015.106

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