ASCT Benefited Younger, Older Multiple Myeloma Patients Equally, Study Finds

Multiple myeloma patients older than 65 years benefit as much as younger patients from autologous stem cell transplant (ASCT), according to a recent retrospective study.

But although the study showed that progression-free survival (PFS) is as good in seniors as in younger patients, no evidence was found for similar survival benefits.

The study, “Efficacy and safety of high-dose chemotherapy with autologous stem cell transplantation in senior versus younger adults with newly diagnosed multiple myeloma,” was published in Hematological Oncology.

In years past, autologous stem cell transplant had become a mainstay of multiple myeloma treatments. It is usually given to patients after high-dose chemotherapy, which is used to kill the myeloma cells.

But because the chemotherapy also kills other cells in the bone marrow that are necessary to replace normal blood cells, doctors first collect the patient’s own stem cells and then re-inject them after chemotherapy. The new blood cells fulfill the role of the lost bone marrow cells and replenish blood cells in the body normally.

ASCT has been offered only in the past few years to older myeloma patients. They previously were considered ineligible based on age alone. Studies now have shown that ASCT in seniors is both safe and beneficial, and may lead to survival improvements.

Now, researchers at the Duke University Medical Center and Duke Cancer Institute sought to examine their institutional experience with ASCT in newly-diagnosed senior multiple myeloma patients, compared to younger ones.

They retrospectively examined 340 myeloma patients who were deemed fit — patients whose physical condition allows them to undergo a medical procedure, often chemotherapy — and who had undergone ASCT. They focused particularly on the ability of ASCT to delay relapse in patients younger than 65 years versus patients older than 65, but overall survival and toxicity also was assessed.

The authors found that ASCT prolongs progression-free survival in older patients at least as well as in younger patients, though overall survival was slightly different between the two groups.

Nonetheless, maintenance therapy, which is given to patients after ASCT to prevent them from relapsing, was given to 28% of younger patients and to 45% of older patients, and the researchers did not exclude that this could be a confounding factor.

Toxicity was similar between the younger and older groups, and mortality due to the transplant was not frequent.

“In summary, ASCT prolongs PFS equally well in older vs. younger adults. Although we cannot exclude maintenance as a confounder, these data support ASCT for fit seniors with MM,” the researchers concluded.