Results of a recent retrospective analysis indicate that stem cell trans­plan­ta­tion may be underutilized in multiple myeloma patients 80 years of age or older.

Researchers from the M. D. Anderson Cancer Center in Houston found that only 0.5 per­cent (9 patients) of the 1,740 multiple myeloma patients who received an au­tol­o­gous (own) stem cell trans­plant between January 2007 and June 2018 at their institution were 80 years or older at the time of their first trans­plant.

Yet the trans­plant out­comes seen in this small sample of patients were favorable, and the toxicity the patients ex­peri­enced during the trans­plant process was, according to the researchers, "acceptable." Most of the side effects the patients ex­peri­enced during the trans­plants were mild to mod­er­ate, and none of the patients died as a result of trans­plant-related com­pli­ca­tions.

All nine of the patients in the M.D. Anderson sample were in their early eighties, with ages ranging from 80 to 83 at the time of trans­plantation. All were in good health, being either fully active, or only somewhat restricted in their physical abilities. (In tech­nical terms, all nine patients had an "ECOG Performance Status" of either 0 or 1.)

Most of the patients (8 of the 9) underwent their trans­plants after their initial myeloma ther­apy. The one patient who underwent a delayed trans­plant did so after their first relapse.

All the patients received a reduced dose of mel­phalan (140 mg/m2) as the chemotherapy part of the trans­plant process.

All patients had at least a partial response after their trans­plant. There were 4 com­plete responses, 2 very good partial responses, and 3 partial responses.

The median pro­gres­sion-free survival was 31.5 months and the median over­all survival has not been reached. The median follow-up time post trans­plant was 9 months.

The researchers point out that the gastro­in­tes­ti­nal side effects asso­ci­ated with the stem cell trans­plant process were mild to mod­er­ate in nature in all patients. Other side effects the researchers observed in the nine patients in­cluded atrial fibrillation, fluid retention, fever accompanied by low white blood cell counts, edema in the lung, stroke, and pleural effusion.

None of the patients died within 100 days of their trans­plant. One patient died 22 months post trans­plant of sudden cardiac arrest. He had pre­vi­ously re­lapsed.

The median length of the inpatient stay for each trans­plant was 17 days. All but one of the patients were able to go directly home after leaving the hospital fol­low­ing their trans­plant. The one patient who could not go directly home needed inpatient rehabilitation. One patient also needed to be re-admitted to hospital within 100 days of the trans­plant.

The researchers also looked at referral patterns and trends in use of stem cell trans­plan­ta­tion at their institution. They found that out of the 1,465 multiple myeloma patients who were referred to their institution for stem cell trans­plant evaluation between January 2013 and December 2017, only 10 (0.7 per­cent) were 80 years or older.

The study authors made a similar observation when they reviewed data for multiple myeloma patients 80 years and older who received treat­ment at M. D. Anderson between January 2002 and 2017. Of the 873 octogenarian patients, only 7 (0.8 per­cent) received a stem cell trans­plant.

The researchers acknowledge that the health status of octogenarians varies sig­nif­i­cantly, ranging from very fit to very frail people, and that the nine patients whose ex­peri­ences they describe in their study are by no means representative of all myeloma patients in their 80s. However, based on their findings, the authors argue that age alone should not preclude an octogenarian multiple myeloma patient from receiving a stem cell trans­plant.

For more in­­for­ma­tion, please see the study by Saini, N. Y. et al., “Melphalan based au­tol­o­gous trans­plant in octogenarian multiple myeloma patients,” in The American Journal of Hematology, October 9, 2018 (article preview ^[1]; full text of article ^[2] [PDF]).