Clinical lymphoma, myeloma & leukemia · 2025
A Large-Scale Analysis of Autologous Stem Cell Transplantation for Multiple Myeloma Patients Older than 65 Years.
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Sáez-Marín Adolfo Jesús, Hernandez-Ibarbu Gema, Alba Lucia Medina, Babio Reyes Mas, Tamayo Andrea, Fonseca Ana Cuervo, Sanchez-Pina Jose María, Alonso-Fernández Rafael Alberto, Lopez-Muñoz Nieves, Blanco Alberto, Justo Pablo, Garcia-Barrio Noelia, Tato Alberto, Cruz Juan Luis, Perez-Rey David, Jimenez-Ubieto Ana, Cruz Javier de la, Calbacho María, Martínez-López Joaquín
Аннотация
INTRODUCTION: The role of autologous hematopoietic stem cell transplantation (auto-HCT) in multiple myeloma (MM) patients over 65 years remains unclear due to their underrepresentation in clinical trials. This study evaluates the safety and efficacy of auto-HCT in this population using real-world data from the TriNetX network.
METHODS: A retrospective cohort study was conducted on MM patients treated at Hospital 12 de Octubre (2013-2023). Three cohorts were analyzed: patients > 65 years undergoing auto-HCT (n = 60), ≤ 65 years with auto-HCT (n = 235), and > 65 years without auto-HCT (n = 59). A validation cohort from TriNetX included 5087 patients > 65 and 10,667 ≤ 65 years receiving auto-HCT, along with 54,757 > 65 years without auto-HCT. Primary outcomes included progression-free survival (PFS), time to next treatment (TNT), overall survival (OS), and non-relapse mortality (NRM).
CONCLUSION: Auto-HCT improved PFS and OS in selected elderly patients. The 6-year PFS was 45.0% (> 65) versus 55.0% (≤ 65) (HR 1.25; P = .365), and the 6-year OS was 57.8% (> 65) versus 81.1% (≤ 65) (HR 2.11; P = .025). TNT rates were similar (64.4% vs. 63.6%; HR 0.93; P < .01). Toxicity and mortality were comparable. These findings support auto-HCT as a valuable consolidation therapy in selected elderly MM patients, emphasizing the need for personalized strategies to optimize outcomes.
METHODS: A retrospective cohort study was conducted on MM patients treated at Hospital 12 de Octubre (2013-2023). Three cohorts were analyzed: patients > 65 years undergoing auto-HCT (n = 60), ≤ 65 years with auto-HCT (n = 235), and > 65 years without auto-HCT (n = 59). A validation cohort from TriNetX included 5087 patients > 65 and 10,667 ≤ 65 years receiving auto-HCT, along with 54,757 > 65 years without auto-HCT. Primary outcomes included progression-free survival (PFS), time to next treatment (TNT), overall survival (OS), and non-relapse mortality (NRM).
CONCLUSION: Auto-HCT improved PFS and OS in selected elderly patients. The 6-year PFS was 45.0% (> 65) versus 55.0% (≤ 65) (HR 1.25; P = .365), and the 6-year OS was 57.8% (> 65) versus 81.1% (≤ 65) (HR 2.11; P = .025). TNT rates were similar (64.4% vs. 63.6%; HR 0.93; P < .01). Toxicity and mortality were comparable. These findings support auto-HCT as a valuable consolidation therapy in selected elderly MM patients, emphasizing the need for personalized strategies to optimize outcomes.