Elderly Patients With Myeloma Still Candidates for Transplant

Despite concerns, elderly patients with myeloma should not have autologous stem cell transplantation (ASCT) written off as one of their treatment options, according to Andrew L. Pecora, M.D.

In an interview with OncLive, a sister publication of CURE, Pecora — who is president of the Physician Services and chief innovation officer at Hackensack Meridian Health – discussed findings of a recent study conducted at the John Theurer Cancer Center that involved 604 patients – 44 of whom were between the ages of 75 and 84 – who underwent ASCT.

Previously, there were concerns that older patients would not be able to handle the toxicities of the procedure, or that their stem cells, which are older, would not work as well.

“The hematopoietic and immunologic reconstitution is just as brisk, as long as you give an adequate dose, as in a younger person,” Pecora said, also mentioning that the toxicities were handled similarly between the older and younger cohorts.

Three-year overall survival was 83.7 percent for the older patients and 82 percent in the younger population. Average overall survival was 93.3 months and 127.8 months for the older and younger groups, respectively. Similarly, the three-year progression-free survival rate was 57.1 percent for the older group and 46 percent for the younger group. Median progression-free survival was 36.1 months and 33.7 months, respectively.

Additionally, older patients were able to tolerate high-dose melphalan conditioning.

“We’ll need to do a larger prospective trial to prove it, but our data strongly suggest that you can safely apply ASCT in an appropriate 75-year-old or older patient, meaning that they have the right performance status, no comorbidities and proper vital function,” Pecora said.

Pecora did mention that if the patient has another health complication, such as unstable diabetes or kidney issues, they likely should not undergo ASCT. But age itself should not be a determining factor, especially if transplant is something that the patient is willing to undergo.

“Age, in and of itself, does not define what a patient feels,” Pecora said. “I know a lot of 90-year-old patients who think they’re young — and some of them live to be 105,” he said. “You have to look at the patient. You have to, obviously, be certain a patient is articulating what they want – the outcome that matters most to them.”

Even with the addition of new drugs and treatment modalities, transplant is still a mainstay in the myeloma space — making it even better that patients of all ages could be fit to endure the procedure.

“Transplant has been the steadiest thing in myeloma treatment over the past 15 years. With the advent of all the new drugs, first-generation immunomodulary agents, monoclonal antibodies, proteasome inhibitors and more, transplant is still there,” Pecora said. “It has still been shown that there is nothing that can provide, at least today, the benefit that a transplant can in a properly assessed patient.”