Age is not a prognostic variable with autotransplants for multiple myeloma

Multiple myeloma (MM) typically afflicts elderly patients with a median age of 65 years. However, while recently shown to provide superior outcome to standard treatment, high-dose therapy (HDT) has usually been limited to pat ients up to 65 years. Among 550 patients with MM and a minimum follow-up of 18 months, 49 aged greater than or equal to 65 years were identified (medi an age, 67; range, 65 to 76 years). Their outcome was compared with 49 youn ger pair mates (median, 52; range, 37 to 64 years) selected among the remai ning 501 younger patients (<65 years) matched for five previously recognize d critical prognostic factors (cytogenetics, beta(2)-microglobulin, C-react ive protein, albumin, creatinine). Nearly one half had been treated for mor e than 1 year with standard therapy and about one third had refractory MM. All patients received high-dose melphalan-based therapy; 76% of the younger and 65% of the older group completed a second transplant (P = .3). Suffici ent peripheral blood stem cells to support two HDT cycles (CD34 > 5 x 10(6) /kg) were available in 83% of younger and 73% of older patients (P = .2). A fter HDT, hematopoietic recovery to critical levels of granulocytes (>500/m u L) and of platelets (>50,000/mu L) proceeded at comparable rates among yo unger and older subjects with both first and second HDT. The frequency of e xtramedullary toxicities was comparable. Treatment-related mortality with t he first HDT cycle was 2% in younger and 8% among older subjects, whereas n o mortality was encountered with the second transplant procedure. Comparing younger/older subjects, median durations of event-free and overall surviva l were 2.8/1.5 years (P = .2) and 4.8/3.3 years (P = .4). Multivariate anal ysis showed pretransplant cytogenetics and PZ. microglobulin levels as crit ical prognostic features for both event-free and overall survival, whereas age was insignificant for both endpoints (P = .2/.8). Thus, age is not a bi ologically adverse parameter for patients with MM receiving high-dose melph alan-based therapy with peripheral blood stem cell support and, hence, shou ld not constitute an exclusion criterion for participation in what appears to be superior therapy for symptomatic MM. (C) 1999 by The American Society of Hematology.