Abstract
Limited information is available on the feasibility and efficacy of autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients >65 years of age. In 1995–2005, 22 myeloma patients ⩾65 years (median 68, eight ⩾70) and 79 patients <65 years (median 57) were included in an identical treatment protocol. The first progenitor cell mobilization with cyclophosphamide plus granulocyte-colony stimulating factor (G-CSF) was successful in 95 and 96% of the patients, respectively. To date, 92 patients have received MEL (melphalan) 200 mg/m2 supported by ASCT. No early treatment-related deaths were observed among 22 elderly patients, whereas one younger patient died early. Engraftment and the need for supportive care were comparable between groups. The elderly patients tended to have more WHO grade 3–4 oral or gastrointestinal toxicity when compared to the younger patients (45 vs 23%, P=0.06). After ASCT, a complete response was observed in 44% of the elderly patients and 36% of the younger patients, respectively. No difference was observed between these age groups in progression-free survival (23 vs 21 months) or overall survival (57 vs 66 months) after ASCT. We conclude that MEL200 is a safe and efficacious treatment in selected elderly myeloma patients.
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
Clavio M, Casciaro S, Gatti AM, Spriano L, Bonanni F, Poggi A et al. Multiple myeloma in the elderly: clinical features and response to treatment in 113 patients. Haematologica 1996; 81: 238–244.
Riccardi A, Mora O, Brugnatelli S, Tinelli C, Spanedda R, De Paoli A et al. Relevance of age on survival of 341 patients with multiple myeloma treated with conventional chemotherapy: updated results of the MM87 prospective randomized protocol. Br J Cancer 1998; 77: 485–491.
Rodon P, Linsassier C, Gauvain JB, Benboubker L, Goupille P, Maigre M et al. Multiple myeloma in elderly patients: presenting features and outcome. Eur J Haematol 2001; 66: 11–17.
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. N Engl J Med 1996; 335: 91–97.
Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. for Medical Research Council Unit Adult Leukaemia Working Party. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.
Barlogie B, Jagannath S, Vesole DH, Naucke S, Cheson B, Mattox S et al. Superiority of tandem autologous transplantation over standard therapy for previously untreated multiple myeloma. Blood 1997; 89: 789–793.
Lenhoff S, Hjorth M, Holmberg E, Turesseon I, Westin J, Nielsen JL et al. for the Nordic Myeloma Study Group. Impact on survival of high-dose therapy with autologous stem cell support in patients younger than 60 years with newly diagnosed multiple myeloma: a population-based study. Blood 2000; 95: 7–11.
Sirohi B, Powles R, Treleaven J, Mainwaring P, Kulkarni S, Pandha H et al. The role of autologous transplantation in patients with multiple myeloma aged 65 years and over. Bone Marrow Transplant 2000; 25: 533–539.
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.
Reece DE, Bredeson C, Perez WS, Jagannath S, Zhang MJ, Ballen KK et al. Autologous stem cell transplantation in multiple myeloma patients <60 vs ⩾60 years of age. Bone Marrow Transplant 2003; 32: 1135–1143.
Moreau P, Facon T, Attal M, Hulin C, Michallet M, Maloisel F et al. Comparison of 200 mg/m2 melphalan and 8 Gy total body irradiation plus 140 mg/m2 melphalan as conditioning regimens for peripheral blood stem cell transplantation in patients with newly diagnosed multiple myeloma: final analysis of the Intergroupe Francophone du Myelome 9502 randomised trial. Blood 2002; 99: 731–735.
Palumbo A, Triolo S, Argentino C, Bringhen S, Dominietto A, Rus C et al. Dose-intensive melphalan with stem cell support (MEL100) is superior to standard treatment in elderly myeloma patients. Blood 1999; 94: 1248–1253.
Samuels BL, Bitran JD . High-dose intravenous melphalan: a review. J Clin Oncol 1995; 13: 1786–1799.
Moreau P, Milpied N, Mahe B, Juge-Morineau N, Rapp MJ, Bataille R et al. Melphalan 220 mg/m2 followed by peripheral blood stem cell transplantation in 27 patients with advanced multiple myeloma. Bone Marrow Transplant 1999; 23: 1003–1006.
Jantunen E, Putkonen M, Nousiainen T, Pelliniemi T-T, Mahlamäki E, Remes K . Low-dose or intermediate-dose cyclophosphamide plus granulocyte colony-stimulating factor for progenitor cell mobilisation in patients with multiple myeloma. Bone Marrow Transplant 2003; 31: 347–351.
Jantunen E, Kuittinen T, Nousiainen T . A pilot study on feasibility and efficacy of amifostine preceding high-dose melphalan with autologous stem cell support in myeloma patients. Leuk Lymphoma 2002; 43: 1961–1965.
Miller AB, Hoogstraten B, Staquet M, Winkler A . Reporting results of cancer treatment. Cancer 1981; 47: 207–214.
Blade J, Samson D, Reece D, Apperley J, Björkstrand B, Gahrton G et al. for the Myeloma Subcommittee of the EBMT. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Br J Haematol 1998; 102: 1115–1123.
Siegel DS, Desikan KR, Mehta J, Singhal S, Fassas A, Munshi N et al. Age is not a prognostic variable with autotransplants for multiple myeloma. Blood 1999; 93: 51–54.
Guba SC, Vesole DH, Jagannath S, Bracy D, Barlogie B, Tricot G . Peripheral stem cell mobilization and engraftment in patients over 60 years of age. Bone Marrow Transplant 1997; 20: 1–3.
Wahlin A, Eriksson M, Hultdin M . Relation between harvest success and outcome after autologous peripheral blood stem cell transplantation in multiple myeloma. Eur J Haematol 2004; 73: 263–268.
Thieblemont C, Dumontet C, Saad H, Roch N, Bouafia F, Amaud P et al. Amifostine reduces mucosal damage after high-dose melphalan conditioning and autologous peripheral blood progenitor cell transplantation for patients with multiple myeloma. Bone Marrow Transplant 2002; 30: 769–775.
Spencer A, Horvath N, Gibson J, Prince HM, Herrmann R, Bashford J et al. Prospective randomised trial of amifostine cytoprotection in myeloma patients undergoing high-dose melphalan conditioned autologous stem cell transplantation. Bone Marrow Transplant 2005; 35: 971–977.
Spielberger R, Stiff P, Bensinger W, Gentile T, Weisdorf D, Kewalramani T et al. Palifermin for oral mucositis after intensive therapy for hematologic cancers. N Engl J Med 2004; 351: 2590–2598.
Terpos E, Apperley JF, Samson D, Giles C, Crawley C, Kanfer E et al. Autologous stem cell transplantation in multiple myeloma: improved survival in non-secretory myeloma but lack of influence of age, status at transplant, previous treatment and conditioning regimen. A single centre experience in 127 patients. Bone Marrow Transplant 2003; 31: 163–170.
Krejci M, Buchler T, Hajek R, Svobodnik A, Krivanova A, Pour L et al. Prognostic factors for survival after autologous transplantation: a single centre experience in 133 multiple myeloma patients. Bone Marrow Transplant 2005; 35: 159–164.
Sirohi B, Powles R, Mehta J, Rudin C, Kulkarni S, Horton C et al. An elective single autograft with high-dose melphalan: single-center analysis of 451 patients. Bone Marrow Transplant 2005; 36: 19–24.
Facon T, Mary JY, Hulin C, Benboubker L, Attal M, Renald M et al. Major superiority of melphalan-prednisone (MP)+thalidomide (Thal) over MP and autologous stem cell transplantation in the treatment of newly diagnosed elderly patients with multiple myeloma. Blood 2005; 106 230a (abstract 780).
Acknowledgements
The study was supported by EVO-grant of Kuopio University Hospital.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Jantunen, E., Kuittinen, T., Penttilä, K. et al. High-dose melphalan (200 mg/m2) supported by autologous stem cell transplantation is safe and effective in elderly (⩾65 years) myeloma patients: comparison with younger patients treated on the same protocol. Bone Marrow Transplant 37, 917–922 (2006). https://doi.org/10.1038/sj.bmt.1705360
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1705360
Keywords
This article is cited by
-
Outcomes with autologous stem cell transplant vs. non-transplant therapy in patients 70 years and older with multiple myeloma
Bone Marrow Transplantation (2021)
-
Gastrointestinal toxicity of high-dose melphalan in autologous hematopoietic stem cell transplantation: identification of risk factors and a benchmark for experimental therapies
Annals of Hematology (2021)
-
Autologous stem cell transplantation in elderly patients with multiple myeloma in Korea: the KMM1807 study
International Journal of Hematology (2020)
-
Challenges and Strategies in the Management of Multiple Myeloma in the Elderly Population
Current Hematologic Malignancy Reports (2019)
-
Melphalan dose in myeloma patients ≥65 years of age undergoing high-dose therapy and autologous stem cell transplantation: a multicentric observational registry study
Bone Marrow Transplantation (2019)