Older Multiple Myeloma Patients Can Be Offered High-Dose Chemo/Transplant’

LONDON—Although age is currently used as an eligibility criteria for inclusion in transplant protocols, a retrospective study from the Royal Marsden Hospital, London, suggests that multiple myeloma patients in their 60s and 70s can safely undergo high-dose chemotherapy with autologous bone marrow or stem cell transplantation.

“Multiple myeloma patients have a median age of onset of 70 years, and improvements in supportive care should enable the delivery of high-dose therapy to patients over 65,” P. N. Mainwaring, MD, said at the ASH meeting.

Using the hospital’s database, the researchers identified 17 multiple myeloma patients who had a first autologous transplant at age 65 years or greater (median, 67; range, 65 to 74). As induction therapy, 13 patients received infusional C/VAMP chemotherapy, and four received interferon-alfa.

As conditioning, 16 patients received high-dose IV melphalan (Alkeran), and one received oral busulphan (Myleran). Fourteen patients received autologous peripheral blood stem cells, and three autologous bone marrow.

Response Rate of 47%

The overall response rate was 47% (8 of 17), with five complete and three partial remissions. Three patients died as a result of the transplant—one with staphylococcus septicemia, one with candidal septicemia, and one with left ventricular failure and progressive disease. One patient has received a second stem cell transplant.

This group was then compared with 370 patients from the Royal Marsden Hospital database who had undergone first transplantation for multiple myeloma (age, 30 to 65 years).

There were no significant differences between the two groups in any outcome parameters: response rate; median number of days to neutrophil recovery, platelet recovery, or discharge; or disease-free or overall survival.

“This study showed that autologous transplant can be offered in select patients up to age 74 after intensive induction chemotherapy, and evaluation is needed for patients above this age,” Dr. Mainwaring said. “It was also shown in selected patients that hematologic toxicities do not limit the delivery of high-dose therapies.”