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Blood, Vol. 93 No. 1 (January 1), 1999:
pp. 51-54
Age Is Not a Prognostic Variable With Autotransplants for Multiple
Myeloma
D.S. Siegel,
K.R. Desikan,
J. Mehta,
S. Singhal,
A. Fassas,
N. Munshi,
E. Anaissie,
S. Naucke,
D. Ayers,
D. Spoon,
D. Vesole,
G. Tricot, and
B. Barlogie
From the Myeloma and Transplantation Research Center, University of
Arkansas for Medical Sciences and Arkansas Cancer Research Center,
Little Rock.
Multiple myeloma (MM) typically afflicts elderly patients with a
median age of 65 years. However, while recently shown to provide
superior outcome to standard treatment, high-dose therapy (HDT) has
usually been limited to patients up to 65 years. Among 550 patients
with MM and a minimum follow-up of 18 months, 49 aged  65 years were
identified (median age, 67; range, 65 to 76 years). Their outcome was
compared with 49 younger pair mates (median, 52; range, 37 to 64 years)
selected among the remaining 501 younger patients (<65 years) matched
for five previously recognized critical prognostic factors
(cytogenetics,  2-microglobulin, C-reactive protein,
albumin, creatinine). Nearly one half had been treated for more than 1 year with standard therapy and about one third had refractory MM. All
patients received high-dose melphalan-based therapy; 76% of the
younger and 65% of the older group completed a second transplant
(P = .3). Sufficient peripheral blood stem cells to support
two HDT cycles (CD34 > 5 × 106/kg) were available
in 83% of younger and 73% of older patients (P = .2).
After HDT, hematopoietic recovery to critical levels of granulocytes
(>500/µL) and of platelets (>50,000/µL) proceeded at comparable
rates among younger and older subjects with both first and second HDT.
The frequency of extramedullary toxicities was comparable.
Treatment-related mortality with the first HDT cycle was 2% in younger
and 8% among older subjects, whereas no mortality was encountered with
the second transplant procedure. Comparing younger/older subjects,
median durations of event-free and overall survival were 2.8/1.5 years
(P = .2) and 4.8/3.3 years (P = .4).
Multivariate analysis showed pretransplant cytogenetics and
2-microglobulin levels as critical prognostic features
for both event-free and overall survival, whereas age was insignificant for both endpoints (P = .2/.8). Thus, age is not a
biologically adverse parameter for patients with MM receiving high-dose
melphalan-based therapy with peripheral blood stem cell support and,
hence, should not constitute an exclusion criterion for participation
in what appears to be superior therapy for symptomatic MM.
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