Multiple Myeloma (MM) In Older (>70 year) Patients - Similar Benefit From Autologous Hematopoietic Cell Transplantation (AHCT) Compared With Younger Patients
Notice bibliographique
Résumé
Abstract Background The median age at diagnosis of MM is 69 years. Randomized, controlled studies on the safety and effectiveness of AHCT are lacking in those > 70 years of age and many patients are considered “ineligible” on the basis of age. We analyzed survival (OS) outcomes of 11,430 MM patients from US and Canada receiving AHCT after high dose melphalan (MEL) between 2008 -2011 reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). The relative efficacy of AHCT was compared in 3 cohorts; those aged ≥70 years (Cohort 1, n=946) vs. those 60-69 years (Cohort 2, n= 4666) and vs. 18-59 years (Cohort 3, n=5818). A statistically representative subset of 1279 patients was then analyzed in further detail to compare relapse, progression free survival (PFS) and non-relapse mortality (NRM). Results The median ages in group 1, 2, and 3 were 72, 64 and 53 years, respectively with an upper age of 89 years. The older age cohort 1 was composed of a higher proportion of male patients, IgA MM, US patients (vs. Canada) and had worse Karnofsky scores (KPS < 100) and co morbidity scores (HCTCI ≥ 2), (all p values <0.05). The older age cohort was less likely to be transplanted within the first year of diagnosis and more likely to have MEL dose reduction (MEL <180 mg/m2 in 42%). Disease status at AHCT did not vary between groups with >40% of patients at least in a very good partial remission (≥VGPR) at transplant in all 3 cohorts. After a median follow up in survivors of 2 years, median OS has not been reached and 3 year OS was inferior for the older cohort at 72% (95% CI, 67-76%), 75% (73-77%), 78% (76-79%) in cohorts 2 and 3 respectively (Figure 1). In multivariate analysis, increasing age was associated with inferior OS (p=0.0006, Fig 1). Hazard ratio for death was 1.12 for cohort 2 vs. 3, 1.35 for cohort 1 vs. 3 and 1.2 for cohort 1 vs. 2. Other significant predictors of lower OS were higher HCTCI score, lower KPS, longer (>12mo) interval from diagnosis to AHCT and inferior disease status ( Further analyses were performed to identify the contribution of relapse, NRM and post relapse survival. NRM within the first year was 0% for the older cohort and 2% for the other 2 cohorts, likely reflecting careful patient selection. Relapse risk at 3 years was similar between cohorts 1,2 and 3 at 63% (48-74%), 51% (55-66%) and 56% (51-60%) respectively. PFS at 3 years was 33% (21-46%), 38% (33-43%) and 42% (37-46%) respectively. In multivariate analyses, increasing age was NOT associated with higher risk of relapse, NRM or lower PFS. KPS <80 was associated with higher risk of relapse, NRM and lower PFS. Other significant risks for relapse and lower PFS were longer interval from diagnosis to AHCT and a < VGPR disease state prior to AHCT. Post relapse survival was significantly worse for the older cohort (p=0.03, Figure 2). Post relapse survival was significantly worse with increasing age. For cohorts 1, 2 and 3 at 2 years, it was 54% vs. 50% and 63% and at 3 yrs 25% vs. 37% and 49% respectively (p=0.03, Fig 2). Conclusions AHCT although performed less frequently in the older MM patient, offers equivalent efficacy in and is associated with low NRM. Survival differences are driven partly by higher co-morbidities and lower post relapse survival. Myeloma related outcomes are similar when appropriate older patients are treated with aggressive therapy. Disclosures: Gasparetto: Onyx: Membership on an entity’s Board of Directors or advisory committees; Millennium (2012): Membership on an entity’s Board of Directors or advisory committees, Speakers Bureau; Celgene ( 2012): Membership on an entity’s Board of Directors or advisory committees, Research Funding, Speakers Bureau. Lonial:Sanofi: Consultancy; BMS: Consultancy; Novartis: Consultancy; Celgene: Consultancy; Millennium: Consultancy; Onyx: Consultancy. Hari:Celgene: Consultancy; Onyx: Consultancy.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».