Autologous stem cell transplantation in elderly multiple myeloma patients over the age of 70 years

Ashraf Badros, Bart Barlogie, Eric Siegel, Christopher Morris, Raman Desikan, Maurizio Zangari, Athanasios Fassas, Elias Anaissie, Nikhil Munshi, Guido Tricot

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196 Scopus citations


The feasibility and efficacy of autologous stem cell transplantation (auto-SCT) in patients aged ≥70 years was analysed. Newly diagnosed (n=34) and refractory multiple myeloma (n=36) patients were studied. The median age was 72 years (range: 70-82.6). CD34+ cells were mobilized with chemotherapy and granulocyte colony-stimulating factor (G-CSF) (n=35) or G-CSF alone (n=35), yielding medians of 11.8×106 versus 8×106 cells/kg respectively (P=0.007). Because of excessive mortality (16%) in the first 25 patients who received melphalan 200 mg/m2 (MEL-200), the dose was subsequently decreased to 140 mg/m2 (MEL-140). Median times to absolute neutrophil count (ANC) >0.5×109/l and to platelets >20×109/l were 11 and 13 d respectively. Thirty-one patients (44%) received tandem auto-SCT. Complete remission (CR) was 20% after the first SCT and 27% after tandem SCT. Median CR duration was 1.5 years and was significantly longer for patients with ≤12 months of prior chemotherapy (2.6 versus 1.0 years, P=0.0008). The 3-year event-free survival (EFS) and overall survival (OS) (+ standard error, SE) were projected at 20%+9% and 31%+10% respectively. Tandem SCTs positively affected EFS (4.0 versus 0.7 years; P=0.003) and OS (4.0 versus 1.4 years; P=0.02) compared with single auto-SCT. In conclusion, MEL-140 is less toxic and appears equally as efficacious as MEL-200 in elderly patients. The benefits of tandem SCT in this patient population need further evaluation in a randomized trial.

Original languageEnglish
Pages (from-to)600-607
Number of pages8
JournalBritish Journal of Haematology
Issue number3
StatePublished - 2001
Externally publishedYes


  • Autologous transplantation
  • Elderly
  • Multiple myeloma
  • Stem cell collection
  • Tandem stem cell transplants


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