ASCT Offers Survival Advantage in Elderly Multiple Myeloma Patients

Autologous stem cell transplant (ASCT) led to significantly longer overall survival (OS) than non-transplant strategies in a cohort of elderly patients with multiple myeloma.

“Multiple myeloma (MM) is a disease of older adults, with almost two-thirds of cases occurring in patients over the age of 65 years,” wrote study authors led by Tanya Wildes, MD, of Washington University School of Medicine in St. Louis. Recent improvements in treatments for MM, however, have led to only mild survival improvements specifically in those older patients. In randomized trials of ASCT, patients over 65 have been specifically excluded, leaving the role of this therapy in older MM patients unclear.

In the new retrospective cohort study, the researchers identified 146 patients between the ages of 65 and 77 years with newly diagnosed MM between 2000 and 2010. Of those, 62 underwent ASCT, and 84 did not. Results were published in Bone Marrow Transplantation.

The median age in the study was 68 years; those who underwent ASCT were younger (67 years) than those who did not (70 years; P < .0001). Other characteristics were similar between the groups.

The median OS for the full cohort was 43.4 months. For those who underwent ASCT, the median OS was 56 months, compared with only 33.1 months for those who did not (P = .004). The 3-year OS in the ASCT patients was 78.3%, compared with 49.5% in the non-ASCT group.

A multivariate analysis confirmed the advantage with ASCT. After controlling for performance status, comorbidity, stage, and propensity to undergo ASCT, the hazard ratio for death with ASCT was 0.52 (95% CI, 0.30–0.91; P = .02). Further sensitivity analyses also confirmed the finding.

“This finding supports the potential utility of ASCT among older adults with MM who are deemed eligible for this treatment option,” the authors wrote. They noted that an observational, retrospective study does have limitations, including the possibility that the survival advantage with ASCT was related to “residual confounding” by factors unaccounted for in the analysis.

“Future studies must focus on prospectively incorporating greater detail on disease characteristics, functional status, and other geriatric assessment parameters in order to further perform comparative effectiveness research to clarify the role of ASCT in older adults with MM,” the authors concluded.