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Plasma Cell Disorders

Autologous stem cell transplant for multiple myeloma patients 70 years or older

Bone Marrow Transplantation volume 51, pages 1449–1455 (2016)Cite this article

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Abstract

Autologous stem cell transplant (Auto-SCT) is increasingly used in older patients with multiple myeloma (MM), despite lack of phase 3 trials in this age-defined population. For 207 consecutive MM patients who underwent Auto-SCT and were 70 years or older at transplant (study cohort), data were analyzed and compared with a younger cohort (1764 Auto-SCT patients <70 years old). The proportion of Auto-SCT in the older patients increased from 7.8% of all transplants in 1998–2006 to 12.9% in 2007–2015. Sixty percent of patients required stem cell mobilization with chemotherapy or plerixafor. Full-dose melphalan conditioning was given to 55% of the older patients compared with 93% of the younger patients (P<0.001). Older patients were more likely to be hospitalized (64% vs 55%; P=0.01), but hospitalization duration was comparable. For newly diagnosed patients, median PFS was 33.5 months for the older cohort and 33.8 months for the younger cohort (P=0.91), and median overall survival was 6.1 and 7.8 years, respectively (P=0.11). Presumably, a smaller fraction of patients, age 70–76, is selected for Auto-SCT, but the benefits are comparable to those seen for younger patients. Reduced-dose melphalan was given to approximately half the patients to avoid excessive toxicity.

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Acknowledgements

Author contributions

EM and MAG designed the study, collected the data, analyzed the data, wrote the first draft, and approved the final version of the manuscript; DD, SK, FKB, AD, SRH, WJH, NL, PK, MQL and SVR provided patient management, critically reviewed the first draft and approved the final version of the manuscript; RCW and RC collected data, provided critical review and approved the final version of the manuscript; and DAG provided patient management, collected data, provided critical review and approved the final version of the manuscript.

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Authors and Affiliations

  1. Division of Hematology, Mayo Clinic, , Rochester, MN, USA

    E Muchtar, D Dingli, S Kumar, F K Buadi, A Dispenzieri, S R Hayman, D A Gastineau, R Chakraborty, W J Hogan, N Leung, P Kapoor, M Q Lacy, S V Rajkumar & M A Gertz

  2. Pharmacy Services, Mayo Clinic, , Rochester, MN, USA

    R C Wolf

  3. Hospitalist Services, Essentia Health-St Joseph’s Center, , Brainerd, MN, USA

    R Chakraborty

  4. Division of Nephrology and Hypertension, Mayo Clinic, , Rochester, MN, USA

    N Leung

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  1. E Muchtar
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Correspondence to M A Gertz.

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Competing interests

SK: Celgene Corp. (consultancy and research funding), Millennium Pharmaceuticals Inc. (consultancy and research funding), Novartis International AG (research funding), Onyx Pharmaceuticals Inc. (consultancy and research funding), AbbVie Inc. (research funding), Janssen Pharmaceuticals, Inc. (consultancy and research funding) and Bristol-Myers Squibb Co. (consultancy and research funding); AD: Celgene Corp (research funding), Millennium Pharmaceuticals Inc. (research funding), Pfizer Inc. (research funding and travel grant) and Janssen Pharmaceuticals Inc. (research funding); PK: Millennium Pharmaceuticals Inc. (Takeda Pharmaceutical Co. Limited) (research funding), Celgene Corp. (research funding) and Onyx Pharmaceuticals Inc. (Amgen Inc.) (research funding); MQL: Celgene Corp. (research funding); MAG: Celgene Corp (honoraria), Millennium Pharmaceuticals, Inc. (consultancy and honoraria), Onyx Pharmaceuticals Inc. (honoraria), Novartis International AG (honoraria) and GlaxoSmithKline PLC (honoraria). The remaining authors declare no conflict of interest.

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Muchtar, E., Dingli, D., Kumar, S. et al. Autologous stem cell transplant for multiple myeloma patients 70 years or older. Bone Marrow Transplant 51, 1449–1455 (2016). https://doi.org/10.1038/bmt.2016.174

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