TABLE 2.
Prospective and Retrospective Studies of ASCT for Older Adult Patients With MM
| First Author | No. of Patients | Patient Population (age in years) | Median (range) Age (years) | Conditioning Regimen | ASCT | TRM (%) | ORR/CR (%) | PFS | OS | Comments |
|---|---|---|---|---|---|---|---|---|---|---|
| Prospective studies | ||||||||||
| Palumbo et al 200459 | 95 | 65–70 | NA | MEL100 | Double | 7 (early deaths) | 68/NA | Median EFS: 28 months | 3-year: 77% | |
| Facon et al 200760 | 126 | 65–75 | ≥ 70 (39% / total population) | MEL100 | Double | 9 | 65/18 | Median: 19.4 months | Median: 38.3 months | |
| Gay et al 201361 | 102 | ≤ 75 | 67 (46–74) | MEL100 | Double | < 70 years: 5 | 95/53 | 5-year: 48% | 5-year: 68% | |
| 70–75 years: 19 | ||||||||||
| Garderet et al 201662 | 56 | ≥ 65 | 67.4 (64–74) | MEL200 (64% of patients) | Single | 0 | 94/40 | 2-year: 76% | 2-year: 88% | Patients in the MEL200 group were slightly younger (68.7 vs. 66.5 years) and had fewer comorbidities (HCT-CI, 0: 79% vs. 50%) |
| MEL140 (36% of patients) | ||||||||||
| Straka et al 201663 | 434 | 60–70 | 65 (60–72) | MEL140 | Double | First-line ASCT: 1.4 | 87/12–17 | Median: 20–21.4 months | Median: 53.4–55.9 months | > 65 years: TRM, 1.1% (first ASCT) and 0% (second ASCT); 60–64 years and 65–70 years: no difference in PFS/OS |
| Second-line ASCT: 0 | ||||||||||
| Nadiminti et al 201864 | 37 | ≥ 65 | 68 (65–75) | MEL200 | Single | 2.7 | 99/47 | 3-year: 82% | 3-year: 90% | |
| Retrospective studies | ||||||||||
| Bashir et al 201265 | 84 | ≥ 70 | 72 (70–80) | MEL200: 65% of patients | NA | All patients: 3 | 85/18 | 5-year: 27% | 5-year: 67% | No difference in grade 3–4 toxicities in patients < 75 and ≥ 75 years |
| MEL140: 25% of | < 75 years: 2 | |||||||||
| patients MEL100: 10% of patients | ≥ 75 years: 6 | |||||||||
| Merz et al 201466 | 202 | ≥ 60 | 65 | MEL200 | Single: 100% | 60–64 years: 2.4 | nCR + CR: | Median: | Median: | |
| Double: 8% | 65–69 years: 1 | 60–64 years: 38 | 60–64 years: 27 months | 60–64 years: NR | ||||||
| 70–75 years: 0 | 65–69 years: 33 | 65–69 years: 23 months | 65–69 years: NR | |||||||
| 70–75 years: 31 | 70–75 years: 23 months | 70–75 years: NR | ||||||||
| Ozaki et al 201467 | 38 | ≥ 65 | 65–68 | MEL200/140 | NA | 0 | NA | Median: 26.8–35. 2 months | NR | |
| Sanchez et al 201768 | 2209 | < 65:74.7% | NA | NA | NA | < 65 years: 2.3 | NA | NA | NA | Patients > 65 years had longer in-hospital stay and higher risk of transplantation-related mortality. |
| ≥ 65: 25.3% | ≥ 65 years: 1.2 | |||||||||
| Stettler et al 201769 | 61 | ≥65 | NA | MEL200: 65–70 years | NA | 65–70 years: 0 | CR: | 2-year: | 2-year: | Patients > 70 years had longer hospitalization time (26 vs. 20 days) than patients 65–70 years |
| MEL140: > 70 years | > 70 years: 0 | 65–70 years: 45 | 65–70 years: 80% | 65–70 years: 96% | ||||||
| > 70 years: 58 | > 70 years: 53% | > 70 years: 100%. | ||||||||
| Belotti et al 201870 | 72 | 65–75 | NA | MEL200: 68% of patients | Single: 70% | 0 | NA | Median: 35.6 months | NA | |
| < MEL200: 32% of patients | Double: 30% | 65–69 years: 51.5 months; ≥ 70 years: 27.7 months | ||||||||
| Ghilardi et al 201871 | 388 | > 65 | 67.5 (65–77) | MEL200: 75.3% | Single: 88.7% | 1.5 | NA | Median: | Median: | |
| MEL70-MEL180: 24.7% | Double: 11.3% | MEL200: 1.4; MEL70-180: 2. | ≤ 70 years: 27.2 months; > 70 years: 21.5 months (p = NS) | ≤ 70 years: 82. 8 months | ||||||
| > 70 years: 56. 2 months (p = .02). | ||||||||||
| Marini et al 201972 | 29 | > 65 | 67 (66–70) | MEL200: 38% | NA | NA | 51 | Median: | NA | |
| MEL140: 62% | MEL200: 62 months; MEL100/140: 45 months | |||||||||
| Mizuno et al 201873 | 287 | ≥ 65 | 66 (65–76) | MEL200/140/100: | Single | < 65 years: 0.4 | NA | NA | 5-year: | |
| < 65 years: 95%/4%/l% of patient | ≥ 65 years: 1.2 | < 65 years: 63% | ||||||||
| ≥ 65 years: 76%/18%/6% of patients | ≥ 65 years 64% | |||||||||
| Saini et al 201874 | 9 | ≥ 80 | 81 (80–83) | MEL140 | Single | 0 | 100/45 | Median: 31.5 months | NR; 2-year 75% | |
Abbreviations: ASCT, autologous stem cell transplantation; CR, complete response; EFS, event-free survival; HCT-CI, Hematopoietic Cell Transplantation-Comorbidity Index; MEL, melphalan; NA, not applicable; nCR, near-complete response; NR, not reported; NS, nonsignificant; ORR, overall response rate; OS, overall survival; PFS, progression-free survival; TRM, treatment-related mortality.