Year: 2007
Type: article
Abstract: Background: Several trials have shown that autologous stem cell transplantation is superior to conventional therapy in terms of complete response (CR) rate, event-free survival (EFS) and overall survival (OS). This treatment, however, is generally limited to patients younger than 65 due to concerns about excessive toxicity and treatment-related mortality (TRM) in older patients. Previous reports have shown that age alone should not exclude patients from high-dose therapy, as long as they fulfill other eligibility criteria. In this report we analyzed the safety and efficacy of high-dose chemotherapy (HDT) and autologous transplant in patients with MM who were ≥ 70 years at the time of autotransplant. Methods: Twenty-six patients (16 males, 10 females) with a median age of 72 (range 70-79) underwent HDT and an autograft between July 1999 and October 2005. The preparative regimen was melphalan 200 mg/m2 in 19 patients (73%), melphalan 180 mg/m2 in 6 and melphalan140 mg/m2 in 1 patient. Of the 26 patients, 12 were receiving first remission consolidation, 7 had primary refractory disease and 7 had relapsed disease. Clonal cytogenetic abnormalities were present in 5 patients (19%). Results: Twenty-two of the 26 patients were alive after a median follow up of 25 months (range 8-74). Responses (complete + partial response) were seen in 20 patients (77%), five (19%) of which were complete responses. Median PFS was 24 months and median OS has not been reached yet. 100-day TRM was 0%. Median times to absolute neutrophil count of ≥0.5 × 109/l and platelets ≥20 × 109/l were 10 and 10 days, respectively. Three-year PFS and OS were 39% and 65%, respectively. A serum albumin <3.5 g/dl (p=0.02), abnormal cytogenetics at transplant (p=0.05) and >2 prior chemotherapy regimens (p=0.02) were associated with a shorter PFS. Patients transplanted with relapsed disease had a shorter OS (p=0.0004). ISS stage, β2 microglobulin level, lactic dehydrogenase (LDH) level, abnormal cytogenetics, CCI or HCT-CI at the time of transplant did not emerge as significant predictors of PFS or OS in this group of patients. Conclusions: HDT and autologous transplant is safe and feasible in selected patients ≥70 years of age. Patients transplanted with relapsed disease had a shorter OS.
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W2028260013