Real-World Outcomes of High Dose Melphalan and Autologous Stem Cell Transplantation in Patients With Multiple Myeloma Older and Younger Than 65 Years.

BACKGROUND

High dose chemotherapy followed by autologous stem cell transplantation (HDT/ASCT) remains the preferred consolidation strategy for patients with newly diagnosed multiple myeloma (MM). While its use has expanded to patients over 65 years (> 65), few studies have compared real-world outcomes to younger patients.

PATIENTS AND

METHODS

This retrospective cohort study included patients with MM who received first line HDT/ASCT between 2013 and 2022 at a large tertiary referral center in The Netherlands. We compared outcomes between patients > 65 years and 65 years or younger (≤ 65), assessing overall survival (OS), time to next treatment or MM-related death (TTNT-D), complications, and quality of life.

RESULTS

Among 394 patients, 109 were > 65 years (range 66-72, 11 patients > 70) and 285 ≤ 65 years (range 34-65). Distributions in baseline characteristics were comparable. Median OS and TTNT-D were 101 and 41 months, respectively, in patients > 65 years compared to 116 (P = .56) and 38 (P = .78) months for patients ≤ 65 years. Age was not a significant predictor. HDT/ASCT was feasible, illustrated by a low serious complications incidence rate and a transplantation-related mortality of 1%. Quality of life data show a stable to increasing trend in the long term.

CONCLUSION

Survival, treatment response, complication rates, and long-term quality of life were comparable between age groups. Our real-world data confirm the safety and efficacy of HDT/ASCT in fit patients with MM over 65 years. These findings support the broader application of HDT/ASCT in selected older patients and reinforce its role.