期刊
CANCER
卷 127, 期 22, 页码 4233-4239出版社
WILEY
DOI: 10.1002/cncr.33831
关键词
elderly; hematopoietic; myeloma; transplantation; utilization
类别
资金
- Public Health Service [U24CA076518]
- National Cancer Institute (NCI)
- National Heart, Lung and Blood Institute (NHLBI)
- National Institute of Allergy and Infectious Diseases [U24HL138660]
- NHLBI [HHSH250201700006C, HHSH250201700007C]
- NCI [OT3HL147741, U01HL128568]
- Health Resources and Services Administration [N00014--20--1--2705, N00014--20--1--2832]
- Office of Naval Research [P01CA111412, R01CA152108, R01CA215134, R01CA218285, R01CA231141, R01AI128775, R01HL126589, R01HL129472, R01HL130388, R01HL131731, U01AI069197, U01AI126612, UG1HL06924]
- BARDA
- Match Foundation
- Boston Children's Hospital
- Medical College of Wisconsin
- National Marrow Donor Program
- Angiocrine Bioscience
- Astellas Pharma US, bluebird bio, Inc
- Celgene Corp
- Daiichi Sankyo Co, Ltd
- Incyte Corp
- Janssen/Johnson Johnson
- Kiadis Pharma
- Kite
- Gilead Company
- Kyowa Kirin
- Magenta Therapeutics
- Merck Sharp Dohme Corp
- Takeda Oncology Co
- Novartis Pharmaceuticals Corp
- Omeros Corp
- Xenikos BV
Autologous hematopoietic stem cell transplantation in multiple myeloma patients aged 75 years and above has shown excellent 2-year outcomes, but remains underutilized in this age group with significant racial and gender disparities.
Background Consolidative autologous hematopoietic stem cell transplantation (AHCT) is commonly used for patients with multiple myeloma (MM). We studied AHCT use and outcomes in patients with MM >= 75 years old. Methods Patients with MM >= 75 years old receiving AHCT between 2013 and 2017 in the United States were identified using the Center for International Blood and Marrow Transplant Research database. Relapse and/or progression (REL), progression-free survival (PFS), and overall survival (OS) were modeled using Cox proportional hazards models. Covariates used were age, sex, Karnofsky performance score (KPS), HCT-comorbidity index (HCT-CI), International Staging System and/or Durie-Salmon stage, high-risk cytogenetics, melphalan dose, and disease status at and 1 year after transplant. AHCT utilization rate using the Surveillance, Epidemiology, and End Results database was used to estimate specific incidence among >= 75 years old by race and gender. Results Of 360 patients, 63% were male, 84% were White, 56% had KPS <90, and 57% had HCT-CI >= 3. The 100-day transplant-related mortality was 1% (0%-2%) with a 2-year REL rate of 27% (95% confidence interval [CI], 22%-33%), PFS of 66% (95% CI, 60%-72%), and OS of 83% (95% CI, 78%-87%). On multivariate analysis, only high-risk cytogenetics was associated with REL risk and decreased PFS. In White males, transplant utilization rate was 5.2%-5.8% compared to 3.5%-4.0% in African American males (P = .02). There was 3.37-3.79% transplant utilization in White females compared to 1.88-2.12% in African American females (P < .01). Conclusions The use of AHCT was associated with excellent 2-year outcomes in this selected MM population >= 75 years old. Transplant utilization for patients >= 75 years old remains low with significant racial and gender disparities.
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