Melphalan dose in myeloma patients ≥65 years of age undergoing high-dose therapy and autologous stem cell transplantation: a multicentric observational registry study

• Published in: Bone marrow transplantation (Basingstoke) Vol. 54; no. 7; pp. 1029 - 1037
• Main Authors: Ghilardi, Guido, Pabst, Thomas, Jeker, Barbara, Müller, Rouven, Cairoli, Anne, Müller, Antonia M S, Bargetzi, Mario, Hitz, Felicitas, Baldomero, Helen, Heim, Dominik, Schmidt, Adrian, Rossi, Davide, Ghielmini, Michele, Wannesson, Luciano, Lerch, Erika, Samaras, Panagiotis, Schanz, Urs, Passweg, Jakob R, Stussi, Georg, Kleber, Martina, Gerber, Bernhard
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01.07.2019
• Subjects: Autografts; Bone marrow; Cytogenetics; Geriatrics; Hematopoietic stem cells; Melphalan; Multiple myeloma; Multivariate analysis; Older people; Remission; Renal function; Stem cell transplantation; Stem cells; Survival; Transplantation
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/s41409-018-0379-y

The optimal melphalan dose prior to autologous stem cell transplantation (ASCT) is not known for elderly multiple myeloma (MM) patients. We analyzed data of all MM patients ≥65 years (n = 388) enrolled in the observational Swiss Blood Stem Cell Transplantation Registry. The median age was 67 years (65-77). Single ASCT was performed in 344 (88.7%) patients, with 259 patients (75.3%) receiving a melphalan dose of 200 mg/m (MEL200), and 85 patients (24.7%) receiving lower doses (MELlow) (median 140 mg/m , range 70-180 mg/m ). MEL200 patients were slightly younger, and had a better renal function, but did not differ with regards to ISS stage, cytogenetic risk, remission status, and KPS. Overall mortality at day 100 was 1.5% without differences between the MEL groups (p = 0.621). Median progression-free survival (PFS) in the MEL200 and the MELlow group was 27.7 and 22.1 months, respectively (p = 0.294). Median overall survival (OS) in the MEL200 and in MELlow group was 91.2 and 61.2 months (p = 0.015). However, multivariate analysis showed no significant association of the melphalan dose and OS (HR 0.734; CI95% 0.264-2.038; p = 0.553). In conclusion, our data reveal no significant differences in safety and PFS for elderly myeloma patients treated with MEL200 or with lower MEL doses.