Though survival outcomes have improved dramatically over the last few decades in newly diagnosed myeloma patients, elderly patients have not yielded the same magnitude of benefit as evidenced by higher rates of reported myeloma-related deaths in patients over the age of 75. This is of particularly importance given this cohort comprises a large proportion of myeloma patients with the median age of diagnosis being 70 years. One contributor to this discrepancy is reduced utilization of high-dose therapy and autologous stem cell transplant (HDT/ASCT) in this population due to concerns for increased toxicity and safety.
The objective of this retrospective analysis is to evaluate survival and safety outcomes in 53 newly diagnosed patients ≥ 74 years of age that underwent HDT/ASCT at our institution in comparison to 122 control patients in the same age bracket that did not undergo stem cell transplant during this same time period.
Patient treated at our institution were identified in our institutional myeloma database by age. They were all treated between November 2006 and October 2016 at the Winship Cancer Institute of Emory University. 53 patients were identified that had undergone HDT/ASCT, and to assess the relative benefit of ASCT, 122 control patients in the same age range were also identified that did not undergo HDT/ASCT during the same time period.
The median age for the entire cohort was 77 years (74 years in the ASCT group vs 78 in the non-ASCT group). Median time to ASCT was 6 months (range, 2-57 months). There were no gender or race differences between the two groups, though a higher proportion of high-risk patients underwent HDT/ASCT. 93% of ASCT patients received triplet induction therapy with a PI+IMID backbone in comparison to only 55% of patients the non-ASCT group. The median PFS for the ASCT group was 50 months versus 30 months in the non-ASCT group. The median OS was 80 months vs 40 months, respectively. In high-risk patients, the median PFS was 60.8 months and the median OS was 77.8 months in the ASCT group compared to 26 months and 38 months in the non-ASCT group, respectively. There were no transplant-related deaths within the first 100 days in the ASCT group.
This study offers real world perspective and data on the safety and survival benefit of ASCT in the elderly population with a near doubling of overall survival when compared to those treated with similar regimens and modern agents without ASCT. This data provides rational for offering ASCT in elderly patients pending a thorough pre-transplant evaluation.

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