Evaluation of the feasibility and efficacy of autologous stem cell transplantation in elderly patients with multiple myeloma

Tsuyoshi Muta, Toshihiro Miyamoto, Tomoaki Fujisaki, Yuju Ohno, Tomohiko Kamimura, Koji Kato, Katsuto Takenaka, Hiromi Iwasaki, Tetsuya Eto, Yasushi Takamatsu, Takanori Teshima, Koichi Akashi

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Abstract

Objective The feasibility and efficacy of high-dose melphalan (HD-MEL) followed by autologous hema- topoietic stem cell transplantation (auto-SCT) in elderly patients with multiple myeloma (MM) are discussed. Methods We retrospectively analyzed and compared the results of 25 elderly patients (aged 65-76 years, elderly group) and 63 control patients (aged 51-64 years, control group). Many patients received a vincristine and doxorubicin combined with dexamethasone (VAD) regimen (elderly group: 92%, control group: 78%) with autologous peripheral blood stem cells being harvested after the administration of chemotherapy with high-dose cyclophosphamide (elderly group: 72%, control group: 87%). Ten elderly patients received MEL at a dose of 100-120 mg/m2, while 15 patients received MEL at a dose of 180-200 mg/m2. Results Treatment-related deaths occurred in one elderly patient and two younger patients due to infections. The rate of achieving complete response (CR) or very good partial response (VGPR) was 60% in the elderly group and 83% in the control group. Progression-free survival from auto-SCT in the elderly group was similar to that observed in the control group (median 17.1 vs. 20.8 months, p=0.26), with the median overall survival (OS) from auto-SCT being 40.8 months in the former and 72.5 months in the latter group (p=0.07). When calculated from the beginning of induction treatment, the median OS of the elderly group was 47.0 months and the 3-year OS rate was 81%. Conclusion The current study provides evidence for the efficacy of auto-SCT in elderly MM patients. A prospective study of auto-SCT in elderly patients using strict eligibility criteria is required to evaluate the prolongation of survival in the era of novel agents.

Original languageEnglish
Pages (from-to)63-70
Number of pages8
JournalInternal Medicine
Volume52
Issue number1
DOIs
Publication statusPublished - Jan 10 2013

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All Science Journal Classification (ASJC) codes

  • Internal Medicine

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