Age no bar: A CIBMTR analysis of elderly patients undergoing autologous hematopoietic cell transplantation for multiple myeloma.

Autor: Munshi PN; MedStar Georgetown University Hospital, Washington, DC., Vesole D; John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey., Jurczyszyn A; Medicini Department of Hematology, Jagiellonian University Medical College, Krakow, Poland.; Krakow Branch Polish Society of Haematology and Blood Transfusion, Krakow, Poland., Zaucha JM; Department of Hematology and Transplantology, Medical University of Gdansk, Gdansk, Poland., St Martin A; Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin., Davila O; Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin., Agrawal V; Division of Hematology-Oncology, Indiana University School of Medicine, Indianapolis, Indiana., Badawy SM; Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Battiwalla M; Sarah Cannon Blood Cancer Network, Nashville, Tennessee., Chhabra S; Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.; Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin., Copelan E; Department of Hematologic Oncology and Blood Disorders, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina., Kharfan-Dabaja MA; Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida., Farhadfar N; Division of Hematology/Oncology, University of Florida College of Medicine, Gainesville, Florida., Ganguly S; Division of Hematological Malignancy and Cellular Therapeutics, University of Kansas Health System, Kansas City, Kansas., Hashmi S; Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.; Oncology Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia., Krem MM; Markey Cancer Center, University of Kentucky College of Medicine, Lexington, Kentucky., Lazarus HM; University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio., Malek E; Seidman Cancer Center, University Hospitals Cleveland Medical Center, Cleveland, Ohio., Meehan K; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire., Murthy HS; Division of Hematology-Oncology, Blood and Marrow Transplantation Program, Mayo Clinic, Jacksonville, Florida., Nishihori T; Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center, Tampa, Florida., Olin RL; University of California at San Francisco, San Francisco, California., Olsson RF; Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden.; Centre for Clinical Research Sormland, Uppsala University, Uppsala, Sweden., Schriber J; Cancer Transplant Institute, Virginia G. Piper Cancer Center, Scottsdale, Arizona.; Arizona Oncology, Scottsdale, Arizona., Seo S; Department of Hematology and Oncology, Dokkyo Medical University, Tochigi, Japan., Shah G; Department of Medicine, Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, New York., Solh M; The Blood and Marrow Transplant Group of Georgia, Northside Hospital, Atlanta, Georgia., Tay J; Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada., Kumar S; Department of Hematology, Mayo Clinic Rochester, Rochester, Minnesota., Qazilbash MH; The University of Texas M.D. Anderson Cancer Center, Houston, Texas., Shah N; University of California at San Francisco, San Francisco, California., Hari PN; Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin., D'Souza A; Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, Wisconsin.
Jazyk: angličtina
Zdroj: Cancer [Cancer] 2020 Dec 01; Vol. 126 (23), pp. 5077-5087. Date of Electronic Publication: 2020 Sep 23.
DOI: 10.1002/cncr.33171
Abstrakt: Background: Upfront autologous hematopoietic stem cell transplantation (AHCT) remains an important therapy in the management of patients with multiple myeloma (MM), a disease of older adults.
Methods: The authors investigated the outcomes of AHCT in patients with MM who were aged ≥70 years. The Center for International Blood and Marrow Transplant Research (CIBMTR) database registered 15,999 patients with MM in the United States within 12 months of diagnosis during 2013 through 2017; a total of 2092 patients were aged ≥70 years. Nonrecurrence mortality (NRM), disease recurrence and/or progression (relapse; REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models with age at transplantation as the main effect. Because of the large sample size, a P value <.01 was considered to be statistically significant a priori.
Results: An increase in AHCT was noted in 2017 (28%) compared with 2013 (15%) among patients aged ≥70 years. Although approximately 82% of patients received melphalan (Mel) at a dose of 200 mg/m 2 overall, 58% of the patients aged ≥70 years received Mel at a dose of 140 mg/m 2 . On multivariate analysis, patients aged ≥70 years demonstrated no difference with regard to NRM (hazard ratio [HR] 1.3; 99% confidence interval [99% CI], 1-1.7 [P = .06]), REL (HR, 1.03; 99% CI, 0.9-1.1 [P = 0.6]), PFS (HR, 1.06; 99% CI, 1-1.2 [P = 0.2]), and OS (HR, 1.2; 99% CI, 1-1.4 [P = .02]) compared with the reference group (those aged 60-69 years). In patients aged ≥70 years, Mel administered at a dose of 140 mg/m 2 was found to be associated with worse outcomes compared with Mel administered at a dose of 200 mg/m 2 , including day 100 NRM (1% [95% CI, 1%-2%] vs 0% [95% CI, 0%-1%]; P = .003]), 2-year PFS (64% [95% CI, 60%-67%] vs 69% [95% CI, 66%-73%]; P = .003), and 2-year OS (85% [95% CI, 82%-87%] vs 89% [95% CI, 86%-91%]; P = .01]), likely representing frailty.
Conclusions: The results of the current study demonstrated that AHCT remains an effective consolidation therapy among patients with MM across all age groups.
(© 2020 American Cancer Society.)
Databáze: MEDLINE
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