Age at transplantation and outcome after autologous stem cell transplantation in elderly patients with multiple myeloma

The optimal treatment of patients with multiple myeloma [MM] is not well defined, in part because these patients are underrepresented in clinical studies. Autologous stem cell transplantation [auto-SCT] after high-dose melphalan chemotherapy can result in a prolonged response duration and survival in patients under 65 years of age. Single-center, retrospective study of patients treated at Paoli-Chalmette Institute Cancer Centre, between January 1994 and January 2007 [96 months] We compared the outcome of elderly [age >65 years] patients with younger patients aged between 60 and 65 years with MM. We compared 82 elderly patients with 104 younger patients. Except for age, both groups had comparable demographic features, disease characteristics, and prognostic factors. Induction VAD chemotherapy was comparable between the elderly [87%] and younger [94%] group. Prior to auto-SCT, the calculated hematopoietic cell transplantation-specific co-morbidity index was also comparable. With a median follow-up of 41 months [range, 5-227 months] after auto-SCT, 120 patients were still alive. Disease progression [n=40; 61%] was the main cause of death, and it was comparable in the two groups. Auto-SCT-related mortality was 3.8% [n=4/104] in younger and 3.7% [n=3/82] in older patients. Comparing younger/older subjects, progression-free survival was significantly higher in the younger group [P<.0001]. However, disease response rates after the first auto-SCT was comparable and overall survival [OS] was also comparable [57% vs. 54% at 5 years, P=NS; 32% vs. 24% at 10 years, P=NS]. In a Cox multivariate analysis model, none of the relevant characteristics was shown to be a critical prognostic feature for OS. Age was insignificant for both OS and transplant-related mortality. We conclude that there is no biological justification for an age-discriminate policy for MM therapy. Physiologic aging is likely more important than chronologic aging