Survival Outcomes After Front-Line Consolidation With High-Dose Melphalan and Autologous Stem Cell Transplantation in Younger and Elderly Multiple Myeloma Patients: A Retrospective Bi-Centric Analysis.

BACKGROUND

High-dose chemotherapy with melphalan (HDCT) and autologous stem cell transplantation (ASCT) represents a gold standard treatment for younger multiple myeloma (MM) patients (<70 years). The benefit of upfront HDCT/ASCT in elderly patients (≥70 years) remains undefined. This analysis investigated survival outcomes among both age groups undergoing front-line HDCT/ASCT.

METHODS

This retrospective analysis included MM patients treated between February 1998 and November 2023 at 2 German university hospitals. Patients were divided into age groups (<70 vs. ≥70), and further categorized whether they received HDCT/ASCT or not. Treatment outcomes, progression-free survival (PFS), and overall survival (OS) were compared using Kaplan-Meier analysis and Cox regression.

RESULTS

Of 517 patients (395 patients <70 years; 122 patients ≥70 years), 343 (66.3%) patients underwent HDCT/ASCT (307 patients <70 years, 89.5% of eligible patients; 36 patients ≥70 years, 10.5% of eligible patients). The remaining 174 (33.7%) patients did not receive HDCT/ASCT (88 patients <70 years; 86 patients ≥70 years). HDCT/ASCT significantly improved both PFS and OS in all patients. Elderly recipients demonstrated longer PFS than younger recipients (10.27 vs. 2.74 years; P = .006), likely due to more frequent use of anti-CD38 antibody-based induction and maintenance therapy. OS was significantly longer in younger recipients (17.31 vs. 4.87 years; P = .003). In the multivariate analysis, HDCT/ASCT remained a strong protective factor for both PFS and OS.

CONCLUSION

HDCT/ASCT confers a significant survival benefit in both younger and selected elderly MM patients. Advanced age alone should not exclude HDCT/ASCT; therefore, transplant-eligibility should be determined by comprehensive assessment of functional status and comorbidities.