Stem Cell Transplant for MM Is Less Common in Older Patients with Comorbidities

Real-world data showed that upfront autologous hematopoietic stem cell transplantation (AHCT) for treatment of multiple myeloma (MM) was less frequently used in older patients and patients with comorbidities, according to a study published in Bone Marrow Transplant.

“Supported by clinical trial proven survival benefit, clinical guidelines recommend upfront AHCT for eligible [patients with] MM,” wrote the study authors. “However, reported real-world utilization is lower than expected.”

Evaluating AHCT Utilization

The researchers used the Australian/New Zealand Myeloma and Related Disease Registry to identify 982 patients treated for MM between June 2012 and May 2020. Overall, 298 patients were aged older than 65 years. The rate of AHCT usage was 76% overall. More patients aged less than 65 years received AHCT compared to patients aged 65 years or older (83% vs. 61%). AHCT was a front-line therapy for 67% of patients.

Patients who did not receive stem cell transplant tended to be older (P <0.001) and had higher rates of comorbidities compared to patients who underwent AHCT. Rates of cardiac disease (16.9% vs. 5.4%), diabetes (19.1% vs. 7.0%), and renal dysfunction (median estimated glomerular filtration rate, 68 vs. 80) were higher for those without versus with AHCT (P <0.001). High-risk MM was also more common in patients who did not undergo transplant (37%) than those who did (26%).

Survival Benefits of Stem Cell Transplant

The use of AHCT led to longer progression-free survival (PFS, 45.3 months) and overall survival (OS, not reached) compared to other therapies (PFS, 35.2 months; OS, 64.0 months). These benefits did not differ by patient age. Among patients older than 65 years, median PFS was 45.3 months and median OS was not reached, compared to 37.7 months and 68.2 months, respectively, in the non-AHCT group. In patients aged 65–70 years, median PFS in the AHCT cohort compared with the non-AHCT cohort was 46.7 months versus 29.2 months (P<0.001), and median OS was 76.9 months versus 55.6 months, respectively (P=0.005).

In conclusion, the authors wrote, “This large, real-world cohort reaffirms AHCT survival benefit, including in ‘older’ patients necessitating well-designed studies evaluating AHCT in ‘older’ MM to inform evidence-based patient selection.”