Autologous stem cell transplantation in elderly multiple myeloma patients over the age of 70 years

The feasibility and efficacy of autologous stem cell transplantation (auto- SCT) in patients aged greater than or equal to 70 years was analysed. Newly diagnosed (n = 34) and refractory multiple myeloma (n = 36) patients were studied. The median age was 72 years (range: 70-82.6). CD34(+) cells were m obilized with chemotherapy and granulocyte colony-stimulating factor (G-CSF ) (n = 35) or G-CSF alone (n = 35), yielding medians of 11.8 x 10(6) versus 8 x 10(6) cells/kg respectively (P = 0.007). Because of excessive mortalit y (16%) in the first 25 patients who received melphalan 200 mg/m(2) (MEL-20 0), the dose was subsequently decreased to 140 mg/m(2) (MEL-140). Median ti mes to absolute neutrophil count (ANC) >0.5 x 10(9)/l and to platelets >20 x 10(9)/l were 11 and 13 d respectively. Thirty-one patients (44%) received tandem auto-SCT. Complete remission (CR) was 20% after the first SCT and 2 7% after tandem SCT. Median CR duration was 1.5 years and was significantly longer for patients with less than or equal to 12 months of prior chemothe rapy (2.6 versus 1.0 years, P = 0.0008). The 3-year event-free survival (EF S) and overall survival (OS) (+ standard error, SE) were projected at 20% 9% and 31% + 10% respectively. Tandem SCTs positively affected EFS (4.0 ve rsus 0.7 years; P = 0.003) and OS (4.0 versus 1.4 years; P = 0.02) compared with single auto-SCT. In conclusion, MEL-140 is less toxic and appears equ ally as efficacious as MEL-200 in elderly patients. The benefits of tandem SCT in this patient population need further evaluation in a randomized tria l.