1. ¹Department of Blood and Marrow Transplantation, University of Texas MD Anderson Cancer Center, Houston, TX, USA
2. ²Department of Lymphoma and Myeloma, University of Texas MD Anderson Cancer Center, Houston, TX, USA

Correspondence: Dr MH Qazilbash, Department of Blood and Marrow Transplantation, UT-MD Anderson Cancer Center, 1515 Holcombe Boulevard-Unit 423, Houston, TX 77030, USA. E-mail: mqazilba@mdanderson.org

Received 14 August 2006; Revised 13 December 2006; Accepted 13 December 2006; Published online 29 January 2007.

Abstract

Several clinical trials have shown the superiority of autologous stem cell transplantation over conventional dose therapy for patients with multiple myeloma. This treatment, however, is limited to younger patients (<65 years) owing to concerns about toxicity and treatment-related mortality (TRM) in older patients. We treated 26 elderly myeloma patients (>70 years), who received a preparative regimen of melphalan 200 mg/m² (19 patients), melphalan 180 mg/m² (six patients) or melphalan 140 mg/m² (one patient). Twenty-two of the 26 patients were alive after a median follow-up of 25 months (range=8–74). Responses (complete+partial response) were seen in 20 patients (77%), five (19%) of which were complete responses. Median PFS was 24 months, whereas median OS has not been reached. Cumulative incidence of 100-day TRM was 0%. Three-year PFS and OS were 39% (range=16–61) and 65% (range=35–83), respectively. A low serum albumin (<3.5 g/dl) was associated with a shorter PFS (P=0.02). Patients with relapsed disease at transplant, and an interval of >12 months between diagnosis and autotransplant, had a shorter OS (P=0.0004 and 0.04). HDT and autologous transplant is safe and feasible in elderly myeloma patients.