Data from a real-world study indicated that autologous stem cell transplantation (ASCT) should be offered to elderly patients with multiple myeloma (MM) pending pre-transplant evaluation. Patients treated with modern agents and transplant had about double the overall survival compared with patients without ASCT.
“We know that ASCT is safe and effective in older patients, but here we demonstrate a significant relative benefit in survival compared to patients in the same age range treated with novel agents alone without consolidative transplant,” the study authors wrote.
The retrospective single-center study looked at survival and safety outcomes in 53 patients with newly diagnosed MM aged 74 years or older. Patients were treated with high-dose therapy (HDT) and ASCT, then compared with 122 control patients of the same age that did not undergo transplant.
The median age of the entire group was 77 years. There were no gender or race differences between the two groups. A higher proportion of patients with high-risk disease underwent ASCT.
Almost all patients (93%) who underwent ASCT received triplet induction therapy with a proteasome inhibitor (PI) plus an immunomodulatory agent (IMID) backbone compared with about half (55%) of patients in the control group.
Median progression-free survival for the ASCT group was 50 months compared with 30 months for the non-ASCT group. Median overall survival was nearly doubled among patients who underwent ASCT (79.67 months vs. 39.79 months).
In patients with high-risk disease, the median progression-free survival was 60.8 months and the median overall survival was 77.8 months in the ASCT group, compared with 26 and 38 months, respectively, in the control group.
The researchers noted that one important limitation of the study is that patients were not matched for age or performance status, which limits the ability to draw definitive conclusions.