Autologous Stem Cell Transplantation in Multiple Myeloma Patients Over 60 Years Old

Bahar Uncu Ulu, Tuğçe Nur Yiğenoğlu, Semih Başcı, Mehmet Bakırtaş, Derya Şahin, Tahir Darçın, Jale Yıldız, Alparslan Merdin, Nuran Ahu Baysal, Dicle İskender, Mehmet Sinan Dal, Merih Kızıl Çakar, Fevzi Altuntaş

Abstract

The incidence of Multiple myeloma (MM) increases with age; two-thirds of the patients are older than 65 years. Induction treatment, including new agents such as thalidomide, bortezomib, and lenalidomide followed by a conditioning regimen and upfront autologous stem cell transplantation (ASCT), has been accepted the standard treatment approach for newly diagnosed fit MM patients. We aimed to search the real-life data, the efficacy and safety of upfront ASCT following induction in patients with MM over 60 years old retrospectively. The data of MM patients who were ≥60 years old during autologous stem cell transplantation and treated at our center between 2010 and 2018 retrospectively analyzed. The study results were 63 patients included at the age of ≥ 60 years who underwent upfront ASCT. Median PFS was 15.5±2.6 months, and the median overall survival (OS) was 28.15±5 months. According to age groups, median PFS was 12±2.3 months in the 60-64 age group, 18.4±6 months in the 65-69 age group, and 26±15 months in the ≥70 age group. Median OS was 26.5±6.1 months in the 60-64 age group, 39.66±8.9 months in the 65-69 age group, and 18 months in the ≥70 age group. A significant relationship between the quantity of infused CD34+ stem cells and PFS and OS (p:0.05 and p<0.00, respectively). Our study indicated that a high dose (200 mg/m2 ) melphalan could safely be used in the physically fit patients at the ages of 60-69, and a reduced amount (140 mg/m2 ) would be the appropriate dose for the patients over 70. The quantity of infused CD34+ stem cells affect elderly MM patients; mobilization dynamics are also important factors for elderly myeloma. Age itself should not consider a barrier to ASCT, and a comprehensive geriatric evaluation should perform on elderly patients

Keywords

Autologous stem cell transplantation; elderly; multiple myeloma; upfront; 60 years old

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References

Badros A, Barlogie B, Siegel E, et al. (2001). Autologous stem cell transplantation in elderly multiple myeloma patients over the age of 70 years. Br J Haematol. 2001, 114,600-607.

Cavo M, Rajkumar SV, Palumbo A et al. (2011) International Myeloma Working Group consensus approach to the treatment of multiple myeloma patients who are candidates for autologous stem cell transplantation. Blood, 117, 6063–6073.

Durie BG, Harousseau JL, Miguel JS et al. (2006). International uniform response criteria for multiple myeloma. Leukemia, 20, 1467–1473.

Facon T, Mary JY, Hulin C 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, 1209–1218.

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

Greipp PR, San Miguel J, Durie BG et al. (2005). International staging system for multiple myeloma. J Clin Oncol, 23, 3412–3420.

Harousseau JL. (2008) Autologous transplantation for multiple myeloma. Ann Oncol, 19 (Suppl 7): vii128–vii133.

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.

Kumar SK, Dispenzieri A, Lacy MQ, et al. (2013). Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia, 28, 1122–1128.

Manapuram S, Hashmi H. (2018). Treatment of Multiple Myeloma in Elderly Patients: A Review of Literature and Practice Guidelines. Cureus, 10(12), e3669

McCarthy PL, Hahn T, Hassebroek A, et al. (2013). Trends in use of and survival after autologous hematopoietic cell transplantation in North America, 1995–2005: significant improvement in survival for lymphoma and myeloma during a period of increasing recipient age. Biol Blood Marrow Transplant, 19, 1116–1123.

Micallef IN, Stiff PJ, Stadtmauer EA, et al. (2013). Safety and efficacy of upfront plerixafor + G-CSF versus placebo + G-CSF for mobilization of CD34(+) hematopoietic progenitor cells in patients ⩾60 and <60 years of age with non-Hodgkin’s lymphoma or multiple myeloma. Am J Hematol, 88, 1017–1023.

Mizuno, S., Kawamura, K., Hanamura, I. et al. (2019). Efficacy and safety of autologous stem cell transplantation in patients aged ≥ 65 years with multiple myeloma in the era of novel agents. Bone Marrow Transplant, 54, 1595–1604

Morris CL, Siegel E, Barlogie B, et al. (2003). Mobilization of CD34+ cells in elderly patients (>/= 70 years) with multiple myeloma: influence of age, prior therapy, platelet count and mobilization regimen. Br J Haematol, 120, 413–423.

Palumbo A, Cavallo F. (2012). Have drug combinations supplanted stem cell transplantation in myeloma? Hematology Am Soc Hematol Educ Program, 2012, 335–341.

Palumbo A, Gay F, Falco P et al. (2010). Bortezomib as induction before autologous transplantation, followed by lenalidomide as consolidation-maintenance in untreated multiple myeloma patients. J Clin Oncol, 28, 800–807.

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

Rajkumar, SV. (2018). Multiple myeloma: 2018 update on diagnosis, risk‐stratification, and management. Am J Hematol, 2018, 93, 1091–1110.

Sharma M, Zhang MJ, Zhong X, et al. (2014). Older patients with myeloma derive similar benefit from autologous transplantation. Biol Blood Marrow Transplant, 20, 1796–1803.

Stettler J, Novak U, Baerlocher GM, et al. (2017). Autologous stem cell transplantation in elderly patients with multiple myeloma: evaluation of its safety and efficacy. Leukemia & Lymphoma, 58(5), 1076-1083.

Straka C, Schaefer-Eckart K, Bassermann F, et al. (2012). Prospective randomized trial of Len/Dex induction followed by tandem MEL 140 with autologous blood stem cell transplantation and Len maintenance versus continued therapy with Len/Dex in myeloma patients age 60–75 years: protocol-defined safety analysis after 100 patients. Blood, 120, 2012. doi: 10.1155/2014/ 394792.

Wildes TM, Rosko A, Tuchman SA. (2014). Multiple myeloma in the older adult: better prospects, more challenges. J Clin Oncol, 32(24), 2531–2540.

Yiğenoglu TN, Basçı S, Ulu BU, et al. (2020). Inferior prognosis in poor mobilizing myeloma patients. Transfusion and Apheresis Science, 59(3), 102722; Doi: 10.1016/j.transci.2020.102722

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