Autologous stem cell transplantation in elderly multiple myeloma patients aged ≥65 years: a two-centre Australian experience

Higher Age (≥60 Years) Increases the Risk for Adverse Events during Autologous Hematopoietic Stem Cell Transplantation

Autologous hematopoietic stem cell transplantation (autoHSCT) is a standard of care for patients with hemato-oncologic diseases. This procedure is highly regulated, and a quality assurance system needs to be in place. Deviations from defined processes and outcomes are reported as adverse events (AEs: any untoward medical occurrence temporally associated with an intervention that may or may not have a causal relationship), including adverse reactions (ARs: a response to a medicinal product which is noxious and unintended). Only a few reports on AEs cover the procedure of autoHSCT from collection until infusion. Our aim was to investigate the occurrence and severity of AEs in a large data set of patients who were treated by autoHSCT. In this retrospective, observational, single-center study on 449 adult patients during the years 2016-2019, AEs occurred in 19.6% of the patients. However, only 6.0% of patients had ARs, which is a low rate compared to the percentages (13.5-56.9%) found in other studies; 25.8% of the AEs were serious and 57.5% were potentially serious. Larger leukapheresis volumes, lower numbers of collected CD34+ cells and larger transplant volumes significantly correlated with the occurrence and number of AEs. Importantly, we found more AEs in patients >60 years (see graphical abstract). By preventing potentially serious AEs of quality and procedural issues, AEs could be reduced by 36.7%. Our results provide a broad view on AEs and point out steps and parameters for the potential optimization of the autoHSCT procedure, especially in elderly patients.

Conditioning with melphalan 200 mg/m2 and subsequent ASCT improves progression-free and overall survival in elderly myeloma patients compared to standard of care

OBJECTIVES

Despite the effectiveness of newer drugs for the treatment of multiple myeloma (MM), the outcomes are further improved by subsequent autologous stem cell transplantation (ASCT). Data on effectiveness in older patients are limited. We compared outcomes in patients aged 65-75 years depending on whether they were treated with ASCT or not and compared those to outcomes in patients <65 years.

METHODS

This was a retrospective, single-center study. We compared progression-free survival (PFS) and overall survival (OS) for all MM patients below and above the age of 65 years treated ± ASCT at the Karolinska University Hospital between 2010 and 2020. PFS and OS were calculated by the Kaplan-Meier method. Variables affecting PFS and OS were evaluated using Cox regression model.

RESULTS

Both PFS and OS were improved in the group 65-75 years treated +ASCT compared to those treated pharmacologically (p = 0.008 and p < 0.001, respectively). There were no significant differences between patients <65 years and those 65-75 years treated with ASCT.

CONCLUSION

The findings indicate that even patients >65 years should be evaluated as candidates for ASCT. An individualized approach supported by a frailty/geriatric assessment score could assist clinicians to select the appropriate treatment for each patient.

Activity and Outcomes of Autologous Stem Cell Transplantation in the Private Sector in Australia

BACKGROUND

Few Australasian Autologous Stem Cell Transplantation (ASCT) programs perform ASCTs in the private sector. Relatively little is known about ASCT outcomes in the private sector, which varies in care delivery models to the public system.

AIMS

We investigated transplantation activity and survival outcomes at Icon Cancer Centre's Brisbane-based private clinical and laboratory ASCT program, over a 23-year period.

METHODS

Retrospective, observational study of all adults who underwent ASCT at Icon between 1996-2018. Main outcome measures were transplant activity, overall survival (OS) and day-100 and 1-year transplant-related mortality (TRM). Outcomes were benchmarked against the Australasian Bone Marrow Transplant Recipient Registry (ABMTRR).

RESULTS

Between 1996-2018, 1676 ASCTs were performed in 1454 patients. From 2010-2018, ASCTs performed at Icon contributed 40% of all South East Queensland ASCTs. In the last 5-years, 21% of Icon's patients were ≥70-years, compared to 5% across Australasia. For the entire cohort, 100-day, and 1-year TRM was 1.1% and 1.7% respectively, whilst for those aged ≥70-years, it was 2.0% and 3.1%. For ASCTs performed between 2014-2018, 100-day and 1-year TRM was 0.8% and 1.4%, which was half the TRM rates reported by the ABMTRR. The 10-year post-transplant OS at Icon was higher than the ABMTRR data, across all disease subtypes.

CONCLUSION

Icon is the largest ASCT contributor in Queensland, with excellent OS and low TRM, demonstrating the critical role of the private sector in the administration of this highly complex therapy. The Icon ASCT program is inclusive of patients aged ≥70-years, demonstrating low and acceptable TRM. This article is protected by copyright. All rights reserved.