Skip to main content
SpringerLink
Log in

Efficacy and safety of autologous hematopoietic cell transplantation in elderly patients with multiple myeloma: a retrospective national multi-site cohort study

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

We aimed to test the efficacy and toxicity of autologous hematopoietic cell transplant (HCT) in Multiple Myeloma (MM) patients aged ≥65 years compared to patients aged 60–64. Two hundred twenty consecutive patients (age ≥65, n = 87) with MM aged 60 and above, who underwent HCT as part of an upfront MM treatment, at four Israeli centers between 2000 and 2014 were included. A melphalan dose of 200 mg/m2 was more frequent in the 60–64 age group vs. the ≥65 age group (77 vs. 57%, p = 0.002). There were no differences between groups in median day of neutrophil engraftment, incidence of infections, grades 3–4 mucositis, cardiovascular events, or non-relapse mortality at 100 days post HCT (4.7, vs. 5%, p = 0.9). A similar rate of improvement in response level was observed (36, vs. 35%, p = 0.87). At 3 years post HCT progression-free survival (PFS) was higher in the 60–64 age group (42 vs. 29%, p = 0.04); however, it was no longer so after adjustment for disease status prior to HCT (p = 0.49). In a Multivariate analysis, melphalan doses and age did not predict PFS. There was no difference in overall survival (OS) between age groups (p = 0.2). We conclude that toxicity profile, response, PFS, and OS of HCT in aged ≥65 patients with myeloma is similar to patients aged 60–64.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Palumbo A, Cavallo F (2012) Review article have drug combinations supplanted stem cell transplantation in myeloma? Blood 120(24):335–341

    Article  Google Scholar 

  2. Harousseau J (2008) Symposium article autologous transplantation for multiple myeloma. Ann Oncol 19(Supplement 7):128–133

    Article  Google Scholar 

  3. Klepin HD, Hurd DD (2006) Autologous transplantation in elderly patients with multiple myeloma: are we asking the right questions? Bone Marrow Transplant 38:585–592

    Article  CAS  PubMed  Google Scholar 

  4. Cavo M, Rajkumar SV, Palumbo A, Moreau P, Orlowski R, Blade J et al (2016) International myeloma working group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation. Blood 117(23):6063–6074

    Article  Google Scholar 

  5. Facon T, Mary JY, Hulin C, Benboubker L, Attal M, Pegourie B et al (2007) Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet 370(9594):1209–1218

    Article  CAS  PubMed  Google Scholar 

  6. Palumbo A, Triolo S, Argentino C, Bringhen S, Dominietto A, Rus C et al (1999) Dose-intensive melphalan with stem cell support (MEL100) is superior to standard treatment in elderly myeloma patients. Blood 94(4):1248–1253

    CAS  PubMed  Google Scholar 

  7. Merz M, Neben K, Raab MS, Sauer S, Egerer G, Hundemer M et al (2014) Autologous stem cell transplantation for elderly patients with newly diagnosed multiple myeloma in the era of novel agents. Ann Oncol 25:189–195

    Article  CAS  PubMed  Google Scholar 

  8. Ozaki S, Harada T, Saitoh T, Shimazaki C, Itagaki M, Asaoku H et al (2014) Survival of multiple myeloma patients aged 65–70 years in the era of novel agents and autologous stem cell transplantation. A multicenter retrospective collaborative study of the Japanese Society of Myeloma and the European myeloma network. Acta Haematol 132:211–219

    Article  PubMed  Google Scholar 

  9. Gay F, Magarotto V, Crippa C, Pescosta N, Guglielmelli T, Cavallo F et al (2013) Bortezomib induction, reduced-intensity transplantation, and lenalidomide consolidation-maintenance for myeloma: updated results. Blood 122(8):1376–1383

    Article  CAS  PubMed  Google Scholar 

  10. Durie BGM, Harousseau J-L, Miguel JS, Bladé J, Barlogie B, Anderson K et al (2006) International uniform response criteria for multiple myeloma. Leukemia 20:1467–1473

    Article  CAS  PubMed  Google Scholar 

  11. McElwain TJ, Powles RL (1983) High-dose intravenous melphalan for plasma-cell leukaemia and myeloma. Lancet 2(8354):822–824

    Article  CAS  PubMed  Google Scholar 

  12. Shaw PJ, Nath CE, Lazarus HM (2014) Not too little, not too much—just right! ( better ways to give high dose melphalan). Bone Marrow Transplant 49(12):1457–1465

    Article  CAS  PubMed  Google Scholar 

  13. Jagannath BS, Vesole DH, Glenn L, Crowley J, Barlogie B (1992) Low-risk intensive therapy for multiple myeloma with combined autologous bone marrow and blood stem cell support. Blood 80(7):1666–1672

    CAS  PubMed  Google Scholar 

  14. Bensinger WI, Becker PS, Gooley TA, Chauncey TR, Maloney DG, Gopal AK et al (2016) A randomized study of melphalan 200 mg/m 2 vs. 280 mg/m 2 as a preparative regimen for patients with multiple myeloma undergoing auto-SCT. Bone Marrow Transplant 51(1):67–71

    Article  CAS  PubMed  Google Scholar 

  15. Sharma M, Zhang M, Zhong X, Abidi MH, Akpek G, Bacher U et al (2014) Biology of blood and marrow transplantation older patients with myeloma derive similar benefit from autologous transplantation. Biol Blood Marrow Transplant 20:1796–1803

    Article  PubMed  PubMed Central  Google Scholar 

  16. Siegel DS, Desikan KR, Mehta J, Singhal S, Fassas A, Munshi N et al (1999) Age is not a prognostic variable with autotransplants for multiple myeloma. Blood 93(1):51–54

    CAS  PubMed  Google Scholar 

  17. Sirohi B, Powles R, Treleaven J, Mainwaring P, Kulkarni S, Pandha H et al (2000) The role of autologous transplantation in patients with multiple myeloma aged 65 years and over. Bone Marrow Transplant 25(5):533–539

    Article  CAS  PubMed  Google Scholar 

  18. Jantunen E, Kuittinen T, Penttila K, Lehtonen P, Mahlamaki E, Nousiainen T (2006) High-dose melphalan (200 mg/m2) supported by autologous stem cell transplantation is safe and effective in elderly (> or = 65 years) myeloma patients: comparison with younger patients treated on the same protocol. Bone Marrow Transplant 37(10):917–922

    Article  CAS  PubMed  Google Scholar 

  19. Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Kumar S, Leung N et al (2007) Impact of age and serum creatinine value on outcome after autologous blood stem cell transplantation for patients with multiple myeloma. Bone Marrow Transplant 39(10):605–611

    Article  CAS  PubMed  Google Scholar 

  20. Kumar SK, Dingli D, Lacy MQ, Dispenzieri A, Hayman SR, Buadi FK et al (2008) Autologous stem cell transplantation in patients of 70 years and older with multiple myeloma: results from a matched pair analysis. Am J Hematol 83(8):614–617

    Article  PubMed  Google Scholar 

  21. El Cheikh J, Kfoury E, Calmels B, Lemarie C, Stoppa A-M, Bouabdallah R et al (2011) Age at transplantation and outcome after autologous stem cell transplantation in elderly patients with multiple myeloma. Hematol Oncol Stem Cell Ther 4(1):30–36

    Article  PubMed  Google Scholar 

  22. Muta T, Miyamoto T, Fujisaki T, Ohno Y, Kamimura T, Kato K et al (2013) Evaluation of the feasibility and efficacy of autologous stem cell transplantation in elderly patients with multiple myeloma. Intern Med 52(1):63–70

    Article  CAS  PubMed  Google Scholar 

  23. Ozaki S, Shimizu K (2014) Autologous stem cell transplantation in elderly patients with multiple myeloma: past, present, and future. Biomed Res Int. doi:10.1155/2014/394792

  24. Auner HW, Szydlo R, Hoek J, Goldschmidt H, Stoppa AM, Morgan GJ et al (2015) Trends in autologous hematopoietic cell transplantation for multiple myeloma in Europe: increased use and improved outcomes in elderly patients in recent years. Bone Marrow Transplant 50:209–215

    Article  CAS  PubMed  Google Scholar 

  25. Kapoor P, Kumar SK, Dispenzieri A, Lacy MQ, Buadi F, Dingli D et al (2013) Importance of achieving stringent complete response after autologous stem-cell transplantation in multiple myeloma. J Clin Oncol 31:4529–4535

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kumar L, Iqbal N, Mookerjee A, Verma RK, Sharma OD, Batra A et al (2014) Complete response after autologous stem cell transplant in multiple myeloma. Cancer Med 3:939–946

    Article  PubMed  PubMed Central  Google Scholar 

  27. Martino M, Postorino M, Gallo GA, Messina G, Neri S, Piro E et al (2014) Long-term results in multiple myeloma after high-dose melphalan and autologous transplantation according to response categories in the era of old drugs. Clin Lymphoma Myeloma Leuk 14:148–154

    Article  PubMed  Google Scholar 

  28. Harousseau J-L, Avet-Loiseau H, Attal M, Charbonnel C, Garban F, Hulin C et al (2009) Achievement of at least very good partial response is a simple and robust prognostic factor in patients with multiple myeloma treated with high-dose therapy: long-term analysis of the IFM 99-02 and 99-04 trials. J Clin Oncol 27(34):5720–5726

    Article  CAS  PubMed  Google Scholar 

  29. Cohen YC, Joffe E, Benyamini N, Dimopoulos MA, Terpos E, Trestman S et al (2016) Primary failure of bortezomib in newly diagnosed multiple myeloma—understanding the magnitude, predictors, and significance. Leuk Lymphoma 57(6):1382–1388

    Article  CAS  PubMed  Google Scholar 

  30. Attal M, Lauwers-Cances V, Hulin C, Facon T, Caillot D, Escoffre M, Arnulf B, MACRO M, Belhadj K, Garderet L, Roussel M, Mathiot C, Avet-Loiseau H, Munshi NC, Richardson PG, Anderson KC, Harousseau JL, Moreau P (2015) Autologous transplantation for multiple myeloma in the era of new drugs: a phase III study of the intergroupe francophone du myelome (IFM/DFCI 2009 trial). Blood 126(23):391

Download references

Author information

Authors and Affiliations

  1. Department of Hematology, Tel-Aviv Sourasky Medical Center, Institute of Hematology, Weizman St. 6, Tel Aviv, Israel

    Yael C Cohen, Svetlana Trestman, Elizabeth Naparstek & Irit Avivi

  2. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Yael C Cohen, Moshe Yeshurun, Hila Magen, Liat Shargian, Elizabeth Naparstek, Irit Avivi & Ron Ram

  3. Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Tsila Zuckerman

  4. Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel

    Tsila Zuckerman, Israel Henig & Eti Ganon-Elazar

  5. Davidoff Cancer Center, Rabin Medical Center, Institute of Hematology, Petah Tikva, Israel

    Moshe Yeshurun, Hila Magen & Liat Shargian

  6. Soroka Medical Center, Hematology Institute, Beer Sheva, Israel

    Itai Levi & Uri Rouvio

  7. BMT Unit, Sourasky Medical Center, Institute of Hematology, Tel Aviv, Israel

    Galit Perez & Ron Ram

Authors
  1. Yael C Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tsila Zuckerman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Moshe Yeshurun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Galit Perez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hila Magen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Israel Henig
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Itai Levi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Liat Shargian
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Svetlana Trestman
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Uri Rouvio
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Elizabeth Naparstek
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Eti Ganon-Elazar
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Irit Avivi
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ron Ram
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yael C Cohen.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cohen, Y.C., Zuckerman, T., Yeshurun, M. et al. Efficacy and safety of autologous hematopoietic cell transplantation in elderly patients with multiple myeloma: a retrospective national multi-site cohort study. Ann Hematol 96, 271–278 (2017). https://doi.org/10.1007/s00277-016-2882-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-016-2882-9

Keywords

Search

Navigation