The role of autologous transplantation in patients with multiple myeloma aged 65 years and over

Autologous stem cell transplantation after high-dose melphalan for the trea tment with multiple myeloma has resulted in prolonged progression-free surv ival and overall survival in patients under 65 years. We have examined the role of autologous transplantation in 17 patients with multiple myeloma ove r 65 years at our centre using a matched pair analysis with younger patient s. The median age of this cohort of patients over 65 years was 67 years (65 -74) and their outcome and transplant-related morbidity was compared with 1 7 younger pair mates with a median age of 55 years (31-64), Sixteen patient s received high-dose melphalan, and one received busulphan with autologous stem cell rescue. The high-dose therapy was well tolerated in both elderly patients and the matched pairs, with comparable time to recover neutrophils and platelets. Treatment-related mortality also did not differ significant ly in both the groups. Median overall survival of the elderly patients was 3.59 years similar to 3.01 years of the pair mates (P = 0.92). Autologous s tem cell transplantation after high-dose melphalan conditioning was equally well tolerated in groups of patients above and below 65 years. There was n o difference in relapse rate, OS and myelotoxicity in both the groups. Thes e findings suggest that advanced age should not be an exclusion criterion f rom autologous transplant programmes.