Evaluation of the Feasibility and Efficacy of Autologous Stem Cell Transplantation in Elderly Patients with Multiple Myeloma
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概要
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Objective The feasibility and efficacy of high-dose melphalan (HD-MEL) followed by autologous hematopoietic stem cell transplantation (auto-SCT) in elderly patients with multiple myeloma (MM) are discussed. Methods We retrospectively analyzed and compared the results of 25 elderly patients (aged 65-76 years, elderly group) and 63 control patients (aged 51-64 years, control group). Many patients received a vincristine and doxorubicin combined with dexamethasone (VAD) regimen (elderly group: 92%, control group: 78%) with autologous peripheral blood stem cells being harvested after the administration of chemotherapy with high-dose cyclophosphamide (elderly group: 72%, control group: 87%). Ten elderly patients received MEL at a dose of 100-120 mg/m2, while 15 patients received MEL at a dose of 180-200 mg/m2. Results Treatment-related deaths occurred in one elderly patient and two younger patients due to infections. The rate of achieving complete response (CR) or very good partial response (VGPR) was 60% in the elderly group and 83% in the control group. Progression-free survival from auto-SCT in the elderly group was similar to that observed in the control group (median 17.1 vs. 20.8 months, p=0.26), with the median overall survival (OS) from auto-SCT being 40.8 months in the former and 72.5 months in the latter group (p=0.07). When calculated from the beginning of induction treatment, the median OS of the elderly group was 47.0 months and the 3-year OS rate was 81%. Conclusion The current study provides evidence for the efficacy of auto-SCT in elderly MM patients. A prospective study of auto-SCT in elderly patients using strict eligibility criteria is required to evaluate the prolongation of survival in the era of novel agents.
著者
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Akashi Koichi
Department Of Medicine & Biosystemic Science Kyushu University
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Muta Tsuyoshi
Department Of Clinical Chemistry And Laboratory Medicine Kyushu University
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Ohno Yuju
Department Of Medicine And Biosystemic Science Graduate School Of Medical Sciences Kyushu University
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Eto Tetsuya
Department Of Hematology Hamanomachi Hospital
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Teshima Takanori
Department Of Biopathological Science Okayama University Graduate School Of Medicine And Dentistry
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Fujisaki Tomoaki
Department Of Internal Medicine Matsuyama Red Cross Hospital
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Takamatsu Yasushi
Division Of Medical Oncology Hematology And Infectious Disease Department Of Medicine Fukouka Univer
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Kato Koji
Department Of Applied Life Science Faculty Of Applied Biological Sciences Gifu University
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Miyamoto Toshihiro
Department Of Hematology Hamanomachi Hospital
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Takenaka Katsuto
Department Of Hematology Hamanomachi General Hospital
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KAMIMURA Tomohiko
Department of Blood and Marrow Transplantation, Hara-Sanshin Hospital
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Eto Tetsuya
Department of Hematology, Hamanomachi Hospital, Japan
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Iwasaki Hiromi
Department of Hematology/Oncology, Kyushu University Hospital, Japan
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Teshima Takanori
Department of Hematology and Oncology, Hokkaido University Graduate School of Medicine, Japan
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Akashi Koichi
Department of Hematology/Oncology, Kyushu University Hospital, Japan
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Takamatsu Yasushi
Division of Medical Oncology, Hematology, and Infectious Disease, Fukuoka University Hospital, Japan
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Miyamoto Toshihiro
Department of Hematology/Oncology, Kyushu University Hospital, Japan
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Fujisaki Tomoaki
Department of Hematology, Matsuyama Red Cross Hospital
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KATO Koji
Department of Agricultural Chemistry, Faculty of Agriculture, Gifu University
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Kato Koji
Department of Hematology/Oncology, Kyushu University Hospital, Japan
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