Supported by clinical trial proven survival benefit, clinical guidelines recommend upfront autologous stem cell transplantation (ASCT) for eligible MM patients. However, reported real-world utilisation is lower than expected (40–60%). We reviewed ASCT utilisation, demographics and outcomes for MM patients (≤70 years, ≥12-month follow-up) enroled onto the Australian/New Zealand MRDR from June 2012 to May 2020. In 982 patients (<65 years: 684, 65–70 years: 298), ASCT utilisation was 76% overall (<65 years: 83%, 65–70 years: 61%, front-line therapy: 67%). Non-ASCT recipients were older (median age: 65 years vs 60 years, p < 0.001), had more comorbidities (cardiac disease: 16.9% vs 5.4%, p < 0.001; diabetes: 19.1% vs 7.0%, p < 0.001; renal dysfunction: median eGFR(ml/min): 68 vs 80, p < 0.001), inferior performance status (ECOG ≥ 2: 26% vs 13%, p < 0.001) and higher-risk MM (ISS-3: 37% vs 26%, p = 0.009, R-ISS-3 18.6% vs 11.8%, p = 0.051) than ASCT recipients. ASCT survival benefit (median progression-free survival (PFS): 45.3 months vs 35.2 months, p < 0.001; overall survival (OS): NR vs 64.0 months, p < 0.001) was maintained irrespective of age (<65 years: median PFS: 45.3 months vs 37.7 months, p = 0.04, OS: NR vs 68.2 months, p = 0.002; 65–70 years: median PFS: 46.7 months vs 29.2 months, p < 0.001, OS: 76.9 months vs 55.6 months, p = 0.005). This large, real-world cohort reaffirms ASCT survival benefit, including in ‘older’ patients necessitating well-designed studies evaluating ASCT in ‘older’ MM to inform evidence-based patient selection.
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The authors thank the patients, hospitals, clinicians, and research staff at participating institutions for their support of the MRDR. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors; however, the ANZ MRDR has received funding from Amgen, Bristol-Myers Squibb, Celgene, Gilead, Janssen, Novartis, Sanofi and Takeda.
Conflict of interest
The authors declare no competing interest.
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Members of the Australian and New Zealand Myeloma and Related Diseases Registry are listed in Supplementary Information.
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Bergin, K., Wellard, C., Augustson, B. et al. Real-world utilisation of ASCT in multiple myeloma (MM): a report from the Australian and New Zealand myeloma and related diseases registry (MRDR). Bone Marrow Transplant 56, 2533–2543 (2021). https://doi.org/10.1038/s41409-021-01308-8