Blood cancers

Aussie real-world cohort reaffirms ASCT survival benefit in ‘older’ patients but many miss out

Real-world data has reaffirmed ASCT survival benefit, including in ‘older’ patients but only 60% of multiple myeloma patients aged 65-70 years received a transplant, new data from the Australian and New Zealand myeloma and related diseases registry (MRDR) shows.

The latest analysis to come from the registry looked at utilisation and 12-month follow-up outcomes for multiple myeloma (MM) patients  enrolled in the registry from June 2012 to May 2020.

Of the 982 patients enrolled over the period 298 were aged 65-70 years. Of those 61% received a transplant compared to 83% of the 684 patients younger than 65.

Median progression free survival was 45.3 months in the <65 years age group vs 35.2 months in the 65-70 years group. A survival benefit that was maintained irrespective of age, according to the data.

Speaking to the limbic, Professor Andrew Spencer, Head of Malignant Haematology and Stem Cell Transplantation at The Alfred Hospital said he was surprised by the numbers.

“In our practice, for example, we transplant people up to 75 so we were a little bit surprised that only about 60% of people aged 65-70 around the country got a transplant – that’s a lot of people not being transplanted in that age range.”

While the registry shows older patients did have more co-morbidities compared to younger patients, including cardiac disease, diabetes, renal dysfunction, and inferior performance status, Professor Spencer said on the whole, patients in the older age group were ‘reasonably’ fit.

“If you look at the percentages of people with comorbidities aged over 65 – 16% had cardiac disease and 19% diabetes for instance – it’s a minority of patients. Most of them are ok and yet 40% are not getting transplanted.

Your average 65-70 year old is reasonably fit and so we’re trying to explore the reasons why ASCT is not used in this group – yes, this is a group that is going to have more comorbidities but even so, the very substantial overall survival benefit really means you need to think carefully about not transplanting someone in that age group”.

Acknowledging that nearly all transplant studies cap participant enrolment criteria at 65 years of age, Professor Spencer said there remains ‘some level of reluctance’ in some centres around the country to transplant patients over 65 if they have other health issues.

“[At our centre] we don’t necessarily rule out transplant for kidney problems, we wouldn’t rule out transplantation for diabetes and people would have to have quite significant cardiac disease for us to not offer an autograft.

Perhaps in some instances co-morbidities were clearly good reasons why these patients weren’t transplanted but I think we need to weight up the risks and benefits… and the risk of transplants in the 65-70 year age group wasn’t particularly different to the younger patients”.

The investigators are calling for more well-designed studies evaluating ASCT in ‘older’ MM to inform evidence-based patient selection.

The study is published in Bone Marrow Transplantation.

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