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HSCT improves survival for older patients with multiple myeloma
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Hematopoietic stem cell transplantation improved OS for elderly patients with multiple myeloma in the real-world setting, according to results of a SEER analysis.
Hematopoietic stem cell transplantation (HSCT) is considered the standard of care for younger patients with multiple myeloma, but there was limited evidence of its efficacy for older patients, according to study background. There has been some debate over the use of HSCT in elderly patients in the medical community as some European clinical guidelines do not recommend HSCT for anyone aged older than 65 years, whereas U.S. guidelines are less restrictive.
Aaron N. Winn, a research associate in the center for the evaluation of value and risk in health at Tufts University, Boston, and colleagues, thus, conducted this study to assess the survival associated HSCT among older patients with multiple myeloma. Researchers also sought to evaluate the performance of different analytical approaches.
The researchers used the SEER database to identify 4,515 patients aged 66 years or older who were diagnosed with multiple myeloma between 2000 and 2007. From that cohort, 263 patients (5.8%) underwent HSCT. Patients undergoing the transplant were more likely to be white, married, younger and have fewer comorbidities.
The median follow-up was 32 months and the mean age at diagnosis was 72.7 years (range, 66-79).
OS improved by 42% among transplant recipients compared with those who did not undergo HSCT (HR = 0.58; 95% CI, 0.49-0.69) based on traditional multivariable analysis. Using a propensity score analysis, OS improved by 43% with HSCT (HR = 0.57; 95% CI, 0.46-0.72). OS improved by 39% using coarsened exact matching (HR= 0.61; 95% CI, 0.49-0.76) and by 47% according to instrumental variable analysis (HR = 0.53; 95% CI, 0.36-0.78).
“This study overcame many of the methodological challenges that have hindered previous studies by using sophisticated analytic methods and a nationally representative database,” Winn and colleagues wrote.
The researchers also noted that although many patients would benefit from HSCT, the procedure is costly; however, greater up-front costs may be offset by lower costs in the long run.
The most notable limitation of the study was the inability to observe certain clinical characteristics in the data — such as patient plasma cell burden, specific lab values, prognostic markers, genetic factors within the tumor, or response to induction therapy — which can influence a patient’s eligibility to receive HSCT, according to the researchers.
“[Yet,] this study found a statistically significant survival benefit from HSCT for older individuals,” the researchers wrote. “These findings were robust across a variety of statistical methods. Given the strength of this result, it’s consistency across methods, and the fact that many patients over the age of 65 are diagnosed with multiple myeloma, clinical trials may be warranted to better understand the effectiveness of HSCT in older adults.” – by Anthony SanFilippo
Disclosure: The researchers report no relevant financial disclosures.
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