Transplant for Multiple Myeloma Effective at Age 75 and Older

Patients aged 75 or older with multiple myeloma (MM) can successfully undergo autologous hematopoietic cell transplantation (AHCT) with outcomes comparable to patients aged 60 to 69, according to the results of a study published in Cancer.

However, utilization of transplant in this population remains low, study researchers noted.

The study included 360 patients aged 75 or older receiving AHCT between 2013 and 2017, identified from the Center for International Blood and Marrow Transplant Research (CIBMTR) database. The median age of patients was 76.3 years.

Overall, outcomes were “excellent”. The 100-day transplant-related mortality was 1%. The 2-year relapse and/or progression rate was 27%. Overall survival was 83%, with a progression-free survival of 66%.

A multivariate analysis showed that only high-risk cytogenetics was associated with risk of relapse or progression (hazard ratio [HR], 2.15; 95% confidence interval [CI], 1.29-3.58; P = 0.003) and a decreased progression-free survival (HR, 1.63; 95% CI, 1.04-2.57; P = 0.033). Stage and disease status at transplant were not associated with outcomes.

The researchers noted that “geriatric assessment and/or frailty testing, as well as patient-reported outcomes data, would have added immense value to the data but these are not routinely practiced across all centers nor captured in the CIBMTR data forms at this time”.

The researchers used data from the Surveillance, Epidemiology, and End Results database to estimate specific incidence of ACHT in patients aged 75 or older by race and gender. They found that white males had a significantly higher transplant utilization rate (5.2%-5.8%) compared with African American males (3.5-4.0%; P = 0.02). Similarly, white females had a higher utilization rate (3.37%-3.79%) compared with African American females (1.88%-2.12%; P <0.01).

Based on these results, the researchers concluded that age alone should not be a criterion to avoid AHCT referral.

“These patients should be referred to transplant centers, just as their younger counterparts, and be given the opportunity for thorough evaluation to determine transplant eligibility,” they wrote.