Here is a study comparing the overall survival of patients aged 65 to 77 diagnosed between 2000 - 2010 based on if they did an autologous transplant or not.
Reference:
TM Wildes et al, "High-dose therapy and autologous stem cell transplant in older adults with multiple myeloma," Bone Marrow Transplantation, May 2015 (abstract)
Abstract:
Randomized trials showing that high-dose therapy with autologous stem cell transplant (ASCT) improved the overall survival (OS) in multiple myeloma (multiple myeloma) excluded patients over age 65. To compare the outcomes of older adults with multiple myeloma who underwent ASCT with non-transplant strategies, we identified 146 patients aged 65–77 with newly diagnosed multiple myeloma seen in the Washington University School of Medicine from 2000 to 2010. Survival among patients who did (N=62) versus did not (N=84) undergo ASCT was compared using Cox proportional hazards modeling, controlling for comorbidities, Eastern Cooperative Oncology Group performance status (PS) and the propensity to undergo ASCT.
Median age was 68 years (range 65–77). PS and comorbidities did not differ significantly between those who did versus those who did not undergo ASCT. Median OS was significantly longer in patients who underwent ASCT than in those who did not (median 56.0 months (95% confidence intervals (CIs) 49.1–65.4) versus 33.1 months (24.3–43.1), P=0.004). Adjusting for PS, comorbidities, Durie–Salmon stage and the propensity to undergo ASCT, ASCT was associated with superior OS (HR for mortality 0.52 (95% CI 0.30–0.91), P=0.02).
In a cohort of older adults with multiple myeloma, undergoing ASCT was associated with a nearly 50% lower mortality, after controlling for PS, comorbidities, stage and the propensity to undergo ASCT.
Forums
Re: Older myeloma patients & autologous transplantation
Hi Mark 11
The study is too small in terms of patient numbers and covers a period where novel drug regimes were rarely used.
This is large scale analysis of non ASCT treated older patients regarding improved survival:
SY Kristinsson et al, "Improved long-term survival in multiple myeloma up to the age of 80 years," Leukemia, Jan 2014 (abstract)
Also, issues around comorbidities, PS, etc, are complex and I am curious about the statement that in two different groups these were similar. These are very individual; risks can be much higher for mortality and morbidity with outcomes unpredictable when ASCT is undertaken.
Not so sure in such a small sample these comorbidities can be meaningfully adjusted for. What we do know is older fit people without comobidities will be like younger people in terms of benefit from ASCT.
Research may not always lack bias (says an ex-oncology researcher).
Edna
The study is too small in terms of patient numbers and covers a period where novel drug regimes were rarely used.
This is large scale analysis of non ASCT treated older patients regarding improved survival:
SY Kristinsson et al, "Improved long-term survival in multiple myeloma up to the age of 80 years," Leukemia, Jan 2014 (abstract)
Also, issues around comorbidities, PS, etc, are complex and I am curious about the statement that in two different groups these were similar. These are very individual; risks can be much higher for mortality and morbidity with outcomes unpredictable when ASCT is undertaken.
Not so sure in such a small sample these comorbidities can be meaningfully adjusted for. What we do know is older fit people without comobidities will be like younger people in terms of benefit from ASCT.
Research may not always lack bias (says an ex-oncology researcher).
Edna
Re: Older myeloma patients & autologous transplantation
Hi Edna,
You wrote:
Novel agents would add benefit to both groups based on every study I have read. Is there a study that shows novel agents benefit those that do not do autologous transplant more than those that do?
Novel agents and autologous transplant complement each other – they are not competing with each other. I have said many times the reason I am doing so well is that I got the benefit of novel agents, high dose chemotherapy, and immunotherapy. All played a role in keeping this high risk patient in a drug-free sustained molecular response.
Mark
You wrote:
The study is too small in terms of patient numbers and covers a period where novel drug regimes were rarely used."
Novel agents would add benefit to both groups based on every study I have read. Is there a study that shows novel agents benefit those that do not do autologous transplant more than those that do?
Novel agents and autologous transplant complement each other – they are not competing with each other. I have said many times the reason I am doing so well is that I got the benefit of novel agents, high dose chemotherapy, and immunotherapy. All played a role in keeping this high risk patient in a drug-free sustained molecular response.
Mark
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Mark11
Re: Older myeloma patients & autologous transplantation
And the study is already 6 years old, so induction therapy was not likely with the newer drugs –Aargh!
(Personally I'm trying to determine if severe diverticulosis is a comorbidity and contraindicates ASCT.)
(Personally I'm trying to determine if severe diverticulosis is a comorbidity and contraindicates ASCT.)
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heddleandhook - Name: heddleandhook
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Jan 2015
- Age at diagnosis: 68
Re: Older myeloma patients & autologous transplantation
Mark11,
Did you not have a SCT?
Did you not have a SCT?
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heddleandhook - Name: heddleandhook
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Jan 2015
- Age at diagnosis: 68
Re: Older myeloma patients & autologous transplantation
Hi heddleandhook,
The original plan was for me to do induction therapy to CR and than do a myeloablative (full conditioning - not a "mini") allogeneic transplant. My insurance company only pays for tandem auto - allo, so I did an auto followed up 4 months later with an allo with myeloablative conditioning. Definitely therapy for a younger, fit patient!
I was not going to do an auto myself, but the studies seem clear to me that, for most myeloma patients, doing an auto leads to increased overall survival. The addition of novel agents improves the outcomes even more.
Mark
The original plan was for me to do induction therapy to CR and than do a myeloablative (full conditioning - not a "mini") allogeneic transplant. My insurance company only pays for tandem auto - allo, so I did an auto followed up 4 months later with an allo with myeloablative conditioning. Definitely therapy for a younger, fit patient!
I was not going to do an auto myself, but the studies seem clear to me that, for most myeloma patients, doing an auto leads to increased overall survival. The addition of novel agents improves the outcomes even more.
Mark
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Mark11
Re: Older myeloma patients & autologous transplantation
It is not often people over 65 in Europe or most elsewhere get offered an ASCT unless they are superfit. This is clearly not the case in all places in the USA.
The studies to date have not been head to head, In the age of novel agents being specifically used up front, studies stratified according to age bands of cohorts of patients receiving comparable groups of agents do not exist.
Robust large scale head-to-head studies which actually are definitive are as yet lacking in the era of widespread novel agent use, although now some are underway. But even then you will get studies where a two drug regimen or three drug regimen are used, and these are not comparable.
As is stated, the study is too old to have had patients who consistently recieved novel agent based therapies versus ASCT with or without novel agents.
Yes, the published research does suggest ASCT gives longer survival to younger patients. The older you, are the shorter your life expectancy, so nothing unusual about OS here in older patients.
Where I am treated, I have met older 8 year survivors who have never had a transplant and a younger person who seemed to have been a 30-year survivor with multiple transplants. I have met people who had transplants and relapsed in months.
I think you my be wanting to read a lot more in the research which cannot predict anything but averages for a very heterogenous disease, where even expert myeloma oncologists cannot predict outcome, only offer the best treatment options for you personally. Humans are not averages.
The studies to date have not been head to head, In the age of novel agents being specifically used up front, studies stratified according to age bands of cohorts of patients receiving comparable groups of agents do not exist.
Robust large scale head-to-head studies which actually are definitive are as yet lacking in the era of widespread novel agent use, although now some are underway. But even then you will get studies where a two drug regimen or three drug regimen are used, and these are not comparable.
As is stated, the study is too old to have had patients who consistently recieved novel agent based therapies versus ASCT with or without novel agents.
Yes, the published research does suggest ASCT gives longer survival to younger patients. The older you, are the shorter your life expectancy, so nothing unusual about OS here in older patients.
Where I am treated, I have met older 8 year survivors who have never had a transplant and a younger person who seemed to have been a 30-year survivor with multiple transplants. I have met people who had transplants and relapsed in months.
I think you my be wanting to read a lot more in the research which cannot predict anything but averages for a very heterogenous disease, where even expert myeloma oncologists cannot predict outcome, only offer the best treatment options for you personally. Humans are not averages.
Re: Older myeloma patients & autologous transplantation
Thanks, Edna.
Other than the diverticulosis, I'm in really good shape. I've run this by 4 myeloma doctors. The 2 who have my full records – one for, one possibly against. But both depending on final restaging, BMB, etc. after 4th round of Velcade, Revlimid, and dex (VRD).
The other two myeloma docs, without all records, just my verbal info, are also one for, one against.
So I'm 50/50 so far. Still researching. I will have harvest sometime mid June, so hope for more info by then.
Other than the diverticulosis, I'm in really good shape. I've run this by 4 myeloma doctors. The 2 who have my full records – one for, one possibly against. But both depending on final restaging, BMB, etc. after 4th round of Velcade, Revlimid, and dex (VRD).
The other two myeloma docs, without all records, just my verbal info, are also one for, one against.
So I'm 50/50 so far. Still researching. I will have harvest sometime mid June, so hope for more info by then.
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heddleandhook - Name: heddleandhook
- Who do you know with myeloma?: self
- When were you/they diagnosed?: Jan 2015
- Age at diagnosis: 68
Re: Older myeloma patients & autologous transplantation
Hi Edna,
I take it from your response that you have never seen a study that suggests that novel agents benefit patients more who do not do auto transplants than those who do. Me either. I am just trying to get someone to explain how giving both groups of patients access to novel agents throughout their treatment course will cut into that 23 month overall survival benefit.
Mark
I take it from your response that you have never seen a study that suggests that novel agents benefit patients more who do not do auto transplants than those who do. Me either. I am just trying to get someone to explain how giving both groups of patients access to novel agents throughout their treatment course will cut into that 23 month overall survival benefit.
Mark
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Mark11
Re: Older myeloma patients & autologous transplantation
Mark 11
You are extrapolating from an abstract, not the full published paper. I do not see the abstract stating information about which drugs were given to this older cohort diagnosed between 2000.and 2010. In 2000 the types of novel drug regimes used now were not the norm, by 2010 some could have been accessed by patients. Also without a lot more details about the patients involved and their health status, drug regimes etc. it is not possible to be more detailed, save comment on its small size.
We all look for what we want to to meet our own particular situation. But as once oncolgy scientist this is not how I approach things. I look at the whole of the fragmented picture to balance risks.
The questions we want answered for ourselves throw up uncertainties for us, most find this a negative when seeking certainty. But I accept the uncertainty at the same time trying to make an intelligent assessment. Much research is undertaken in instutions which never publish negative findings and conduct research in silo fashion. Very systematic research is less frequent as is large scale collaborative research. So you get one paper saying one thing and another the opposite. Both may have truth, but the way the studies have been undertaken may not show up why they differ in their findings.
We all want to have long OS, but these papers will not tell us individually our chances of this happening. The guidance comes from the skills, knowledge of your myeloma specialist and the quality of the supporting care you receive to maximise your chances of long survival without compromising on QOL.
I hope your specialist greets you with great news next year.
Edna .
Edna
You are extrapolating from an abstract, not the full published paper. I do not see the abstract stating information about which drugs were given to this older cohort diagnosed between 2000.and 2010. In 2000 the types of novel drug regimes used now were not the norm, by 2010 some could have been accessed by patients. Also without a lot more details about the patients involved and their health status, drug regimes etc. it is not possible to be more detailed, save comment on its small size.
We all look for what we want to to meet our own particular situation. But as once oncolgy scientist this is not how I approach things. I look at the whole of the fragmented picture to balance risks.
The questions we want answered for ourselves throw up uncertainties for us, most find this a negative when seeking certainty. But I accept the uncertainty at the same time trying to make an intelligent assessment. Much research is undertaken in instutions which never publish negative findings and conduct research in silo fashion. Very systematic research is less frequent as is large scale collaborative research. So you get one paper saying one thing and another the opposite. Both may have truth, but the way the studies have been undertaken may not show up why they differ in their findings.
We all want to have long OS, but these papers will not tell us individually our chances of this happening. The guidance comes from the skills, knowledge of your myeloma specialist and the quality of the supporting care you receive to maximise your chances of long survival without compromising on QOL.
I hope your specialist greets you with great news next year.
Edna .
Edna
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