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Efficacy and safety of autologous stem cell transplantation in patients aged ≥ 65 years with multiple myeloma in the era of novel agents

Bone Marrow Transplantation volume 54, pages 1595–1604 (2019)Cite this article

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Abstract

Clinical trials evaluating the role of autologous hematopoietic stem cell transplantation (auto-HCT) in multiple myeloma have mostly included patients aged <65 years. Therefore, this study was aimed to evaluate the efficacy and safety of auto-HCT in elderly patients with multiple myeloma in the era of novel agents. We retrospectively analyzed 2056 patients with multiple myeloma, who underwent auto-HCT in 2007–2014 (287 were aged ≥65 years). We evaluated the 100-day treatment-related mortality (TRM) and overall survival (OS) in two groups; elderly patients ( ≥65 years) who underwent auto-HCT compared with younger patients ( <65 years). In the propensity score–matched-pair analysis used to adjust for possible selection bias, the incidence of 100-day TRM between patients aged <65 (0.4%; 95% confidence interval [CI]: 0.0–2.0%) and ≥65 years (1.2%; 95% CI: 0.3–3.1%) showed no statistically significant difference (p = 0.31). The probability of the 5-year OS after transplantation in those aged <65 (62.5%; 95% CI: 58.6–66.1%) and ≥65 (63.5%; 95% CI: 52.2–72.7%) years was also not significantly different (p = 0.56). This study showed that the safety and efficacy of auto-HCT in elderly patients with multiple myeloma in the era of novel agents compared with younger patients were similar.

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Acknowledgements

We thank Ms A Nakamura for her valuable secretarial assistance and all of the physicians and staff members of the collaborating institutes of the Japan Society for Hematopoietic Stem Cell Transplantation.

Funding

This work was supported in part by the Practical Research Project for Allergic Diseases and Immunology (Research Technology of Medical Transplantation) from Japan Agency for Medical Research and Development, AMED under Grant Number 18ek0510023h0002.

Author contributions

SM designed the research and wrote the first draft of the manuscript. SM and KK analyzed the data and performed the statistical analysis. KK, IH, KS, HT, and AT contributed to the critical review of the manuscript. All the other authors contributed to data collection. All authors approved the final version.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan

    Shohei Mizuno, Ichiro Hanamura & Akiyoshi Takami

  2. Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan

    Koji Kawamura, Shinichi Kako & Yoshinobu Kanda

  3. Department of Hematology, National Hospital Organization Okayama Medical Center, Okayama, Japan

    Kazutaka Sunami & Masanori Makita

  4. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    Takehiko Mori

  5. Division of Hematology, National Center for Global Health and Medicine, Tokyo, Japan

    Fumihiko Nakamura

  6. Department of Hematology and Oncology, Nagoya City University Hospital, Nagoya, Japan

    Shinsuke Iida

  7. Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan

    Hideyuki Nakazawa

  8. Department of Hematology and Oncology, Anjo Kosei Hospital, Anjo, Japan

    Masashi Sawa

  9. Department of Hematology/Oncology and Transfusion and Hemapheresis Center, Kurashiki Central Hospital, Kurashiki, Japan

    Yasunori Ueda

  10. Department of Hematology and Clinical Immunology, Yokohama City University Hospital, Yokohama, Japan

    Hiroyuki Takahashi

  11. Department of Hematology and Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan

    Tatsuo Ichinohe

  12. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

    Yoshiko Atsuta

  13. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

    Yoshiko Atsuta

  14. Faculty of Medicine, Department of Hematology/Respiratory Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan

    Hiroyuki Takamatsu

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  1. Shohei Mizuno
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Correspondence to Shohei Mizuno.

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Conflict of interest

SM received honoraria from Takeda Pharmaceutical Co., Ltd. and received research funding from Kyowa Hakko Kirin Co., Ltd, Chugai Pharmaceutical Co., Ltd, and Bristol-Myers Squibb Corporation. IH received lecture fee from Celgene Corporation, Bristol-Myers Squibb Corporation, Janssen Corporation, Takeda Pharmaceutical Co., Ltd, and Eisai Co., Ltd, and received research funding from Fujimoto Pharmaceutical Corporation, Kyowa Hakko Kirin Co., Ltd, Chugai Pharmaceutical Co., Ltd, and Bristol-Myers Squibb. KS received honoraria from Ono Pharmaceutical Co., Ltd, Bristol-Myers Squibb Corporation, and Celgene Corporation, and received research funding from Ono Pharmaceutical Co., Ltd, Bristol-Myers Squibb Corporation, Celgene Corporation, Janssen Corporation, Takeda Pharmaceutical Co., Ltd, Sanofi Corporation, Abbvie Corporation, GlaxoSmithKline plc, MSD Corporation, and Daiichi Sankyo Co., Ltd. HT received honoraria from Celgene Corporation and Janssen Corporation, and received research funding from Ono Pharmaceutical Co., Ltd, Bristol-Myers Squibb, and Celgene Corporation. AT received research funding from Kyowa Hakko Kirin Co., Ltd, Chugai Pharmaceutical Co., Ltd, and Bristol-Myers Squibb Corporation.

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Mizuno, S., Kawamura, K., Hanamura, I. et al. Efficacy and safety of autologous stem cell transplantation in patients aged ≥ 65 years with multiple myeloma in the era of novel agents. Bone Marrow Transplant 54, 1595–1604 (2019). https://doi.org/10.1038/s41409-019-0478-4

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