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Outcomes with autologous stem cell transplant vs. non-transplant therapy in patients 70 years and older with multiple myeloma

Bone Marrow Transplantation volume 56, pages 368–375 (2021)Cite this article

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Abstract

We evaluated 79 patients with multiple myeloma (MM) ≥70 years referred to our blood and marrow transplant clinic, within 1 year of diagnosis from 2010 to 2019, for consideration of autologous stem cell transplant (ASCT). Thirty-eight (48%) of 79 patients underwent ASCT. ASCT was not pursued in 41 (52%) patients due to: patient or physician preference in 80% (n = 33) or ineligibility in 20% (n = 8). Baseline characteristics of patients in the two groups were similar. Median PFS from treatment start amongst patients undergoing ASCT (n = 38) vs. not (n = 41) was 41 months vs. 33 months, p = 0.03. There was no difference in OS, with estimated 5-year OS of 73% vs. 83%, respectively (p = 0.86). Day +100 transplant-related mortality (TRM) was 0%. ASCT was an independent favorable prognostic factor for PFS in multivariate analysis, after accounting for HCT-CI score, performance status, hematologic response, and maintenance. Finally, patients ≥70 years undergoing ASCT had similar PFS compared to a contemporaneous institutional cohort of patients <70 years (n = 631) (median PFS from transplant: 36 vs. 47 months, p = 0.25). In this retrospective analysis, ASCT was associated with low TRM and better PFS in fit older adults with MM compared to non-transplant therapy, with comparable benefits as seen in younger patients.

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Fig. 1: Survival outcomes in patients 70 years and above undergoing ASCT vs. non-ASCT based treatment.
Fig. 2: Progression free survival compared to a younger patient cohort.

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Acknowledgements

We would like to acknowledge the Stanford BMT Database Management team.

Funding

Surbhi Sidana, MD was supported by KL2TR003143, KL2 Mentored Career Development Program, Stanford Clinical Translational Science Award Program.

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Authors and Affiliations

  1. Stanford Cancer Institute, Stanford University Medical Center, Stanford, CA, USA

    Christopher Lemieux, Lori S. Muffly, Andrew Rezvani, Robert Lowsky, David J. Iberri, Juliana K. Craig, Matthew J. Frank, Laura J. Johnston, Michaela Liedtke, Robert Negrin, Wen-Kai Weng, Everett Meyer, Judith Shizuru, Parveen Shiraz, Sally Arai, David B. Miklos & Surbhi Sidana

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Contributions

CL designed the study, collected and analyzed the data, and wrote the paper. SS designed the study, analyzed the data, and wrote the paper. LM, AR, RL, DI, JC, MF, LJ, ML, RN, WKW, EM, JS, PS, SA, and DM critically appraised the paper.

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Correspondence to Surbhi Sidana.

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SS: Consultancy: Janssen. AR: Research Support, Pharmacyclics; one-time advisory boards for Nohla and Kaleido; expert witness, U.S. Department of Justice; brother employed by Johnson & Johnson.

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Lemieux, C., Muffly, L.S., Rezvani, A. et al. Outcomes with autologous stem cell transplant vs. non-transplant therapy in patients 70 years and older with multiple myeloma. Bone Marrow Transplant 56, 368–375 (2021). https://doi.org/10.1038/s41409-020-01026-7

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