Autologous Stem Cell Transplants Are Safe for Older Multiple Myeloma Patients

Anita D'Souza, MD

Autologous hematopoietic cell transplantation is a safe, effective, and beneficial treatment for older patients with multiple myeloma, according to new research presented at the American Society of Hematology (ASH) 2019 Annual Meeting in Orlando.

Although just 4 of 10 patients receive this therapy, the findings suggest more patients could benefit from autologous hematopoietic cell transplantation therapy than have typically been offered it.

Lead study author Anita D’Souza, MD, of the Medical College of Wisconsin, and colleagues analyzed approximately 16,000 health records from the Center for International Blood and Marrow Transplant Research database of patients who received autologous hematopoietic cell transplantation with melphalan—a conditioning chemotherapy drug—in the US between 2013—2017.

The investigators not only found the therapy is safe and effective in patients older than 70 years of age, but that patients were better off when given the normal melphalan dose of 200 mg/m2, rather than the reduced dose of 140 mg/m2 given to older patients.

Patients who received a reduced dose had significantly worse outcomes and lower survival rates.

Among the patients at least 70 years old, melphalan dose was a surrogate for worse outcomes including non-relapse mortality at 100 days (Melphalan 140, 1% vs Melphalan 200, 0%; P = .003), progression-free survival at 2 years (Melphalan 140, 64% vs Melphalan 200, 69%; P = .003) and overall survival at 2 years (Melphalan 140, 85% vs Melphalan 200, 89%, P = .01).

The worse outcomes could be due to higher frailty to begin with, D’Souza said. In which case, the negative results would not necessarily be due to the reduction in melphalan dosing.

Compared to patients aged 60—69, those who were at least 70 years old had similar non-relapse mortality (HR, 1.3; 95% CI, 1–1.7; P = .06), relapse/progression (HR, 1.03; 95% CI, 0.9—1.1, P = .6), progression-free survival (HR, 1.06; 95% CI, 1—1.2, P = .2), and overall survival (HR, 1.2; 95% CI, 1—1.4; P = .02).

There was a higher proportion of high-risk cytogenetics in patients at least 70 years old (30%), compared to patients 40—49 years (24%) and 20–39 years (20%).

More autologous stem cell transplantations were performed in the older group in 2017 (28%) compared to 2013 (15%).

The investigators noted the findings also point out important racial disparities in myeloma care. African Americans patients are twice as likely to have myeloma than white patients, but have significantly lower autologous hematopoietic cell transplantation.

The study, “Breaking the Glass Ceiling of Age in Transplant in Multiple Myeloma,” was presented Monday at ASH 2019.