Clinical significance of high-dose chemotherapy with autologous stem cell transplantation in the era of novel agents in patients older than 65 years with multiple myeloma

被引:0
作者
Shuku Sato
Shun Tsunoda
Teiko Kawahigashi
Wataru Kamata
Yotaro Tamai
机构
[1] Shonan Kamakura General Hospital,Division of Hematology
来源
Annals of Hematology | 2023年 / 102卷
关键词
Autologous stem cell transplantation; Multiple myeloma; Older patients; Complete response; Progression-free survival;
D O I
暂无
中图分类号
学科分类号
摘要
High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is the standard treatment for symptomatic multiple myeloma (MM) in patients under 65 years of age. However, the performing of ASCT in older patients > 65 years without comorbidities or complications is controversial. Introduction of novel drugs, such as daratumumab, has improved the long-term survival of patients with MM who are ineligible for ASCT. This retrospective study aimed to evaluate the clinical significance of ASCT in older patients, even in the era of novel drugs. A total of 55 patients aged 65–74 years (15 ASCT recipients and 40 ASCT-ineligible patients) newly diagnosed with MM between March 2013 and October 2021 at our institution were analyzed in this study. There were no significant differences in the 3-year overall survival (84.6% vs. 90.6%, p = 0.72) and progression-free survival (PFS) (61.2% vs. 75.1%, p = 0.40) between ASCT recipients and ASCT-ineligible patients. There was also no significant difference in complete response (CR) with minimal residual disease (MRD)-negative rate between the two groups (27% vs. 33%, p = 1.0). Multivariate analysis showed that CR was an independent predictor of PFS (hazard ratio [HR], 0.26; 95% confidence interval, 0.08–0.76; p = 0.01). In this retrospective study, despite patients who were determined to be intolerant to ASCT, the non-ASCT group was non-inferior to the ASCT group in PFS and overall response rate. The results of this study confirm that the significance of ASCT is diminishing in patients 65 years of age and older because newer agents can achieve good responses without ASCT.
引用
收藏
页码:1185 / 1191
页数:6
相关论文
共 221 条
[1]  
Attal M(2017)Lenalidomide, bortezomib, and dexamethasone with transplantation for myeloma N Engl J Med 376 1311-1320
[2]  
Lauwers-Cances V(2022)Triplet therapy, transplantation, and maintenance until progression in myeloma N Engl J Med 387 132-147
[3]  
Hulin C(2003)High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma N Engl J Med 348 1875-1883
[4]  
Leleu X(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
[5]  
Caillot D(2012)Feasibility of autologous hematopoietic stem cell transplant in patients aged ≥70 years with multiple myeloma Leuk Lymphoma 53 118-122
[6]  
Escoffre M(2008)Autologous stem cell transplantation in patients of 70 years and older with multiple myeloma: results from a matched pair analysis Am J Hematol 83 614-617
[7]  
Richardson PG(2015)High-dose therapy and autologous stem cell transplant in older adults with multiple myeloma Bone Marrow Transplant 50 1075-1082
[8]  
Jacobus SJ(2016)Survival of elderly patients with multiple myeloma – effect of upfront autologous stem cell transplantation Eur J Cancer 62 1-8
[9]  
Weller EA(2016)Upfront autologous stem cell transplantation for newly diagnosed elderly multiple myeloma patients: a prospective multicenter study Haematologica 101 1390-1397
[10]  
Hassoun H(2021)Daratumumab, lenalidomide, and dexamethasone versus lenalidomide and dexamethasone alone in newly diagnosed multiple myeloma (Maia): overall survival results from a randomized, open-label, phase 3 trial Lancet Oncol 22 1582-1596