Mizuno Shohei, Kawamura Koji, Hanamura Ichiro, Sunami Kazutaka, Mori Takehiko, Nakamura Fumihiko, Iida Shinsuke, Nakazawa Hideyuki, Makita Masanori, Kako Shinichi, Sawa Masashi, Ueda Yasunori, Takahashi Hiroyuki, Kanda Yoshinobu, Ichinohe Tatsuo, Atsuta Yoshiko, Takamatsu Hiroyuki, Takami Akiyoshi
Division of Hematology, Department of Internal Medicine, Aichi Medical University, Nagakute, Japan.
Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Bone Marrow Transplant. 2019 Oct;54(10):1595-1604. doi: 10.1038/s41409-019-0478-4. Epub 2019 Feb 19.
Clinical trials evaluating the role of autologous hematopoietic stem cell transplantation (auto-HCT) in multiple myeloma have mostly included patients aged <65 years. Therefore, this study was aimed to evaluate the efficacy and safety of auto-HCT in elderly patients with multiple myeloma in the era of novel agents. We retrospectively analyzed 2056 patients with multiple myeloma, who underwent auto-HCT in 2007-2014 (287 were aged ≥65 years). We evaluated the 100-day treatment-related mortality (TRM) and overall survival (OS) in two groups; elderly patients ( ≥65 years) who underwent auto-HCT compared with younger patients ( <65 years). In the propensity score-matched-pair analysis used to adjust for possible selection bias, the incidence of 100-day TRM between patients aged <65 (0.4%; 95% confidence interval [CI]: 0.0-2.0%) and ≥65 years (1.2%; 95% CI: 0.3-3.1%) showed no statistically significant difference (p = 0.31). The probability of the 5-year OS after transplantation in those aged <65 (62.5%; 95% CI: 58.6-66.1%) and ≥65 (63.5%; 95% CI: 52.2-72.7%) years was also not significantly different (p = 0.56). This study showed that the safety and efficacy of auto-HCT in elderly patients with multiple myeloma in the era of novel agents compared with younger patients were similar.
评估自体造血干细胞移植（auto-HCT）在多发性骨髓瘤中作用的临床试验大多纳入了年龄小于65岁的患者。因此，本研究旨在评估在新型药物时代auto-HCT治疗老年多发性骨髓瘤患者的疗效和安全性。我们回顾性分析了2007年至2014年间接受auto-HCT的2056例多发性骨髓瘤患者（其中287例年龄≥65岁）。我们评估了两组患者的100天治疗相关死亡率（TRM）和总生存期（OS）；将接受auto-HCT的老年患者（≥65岁）与年轻患者（<65岁）进行比较。在用于调整可能的选择偏倚的倾向评分匹配对分析中，年龄<65岁（0.4%；95%置信区间[CI]：0.0-2.0%）和≥65岁（1.2%；95%CI：0.3-3.1%）患者的100天TRM发生率无统计学显著差异（p=0.31）。年龄<65岁（62.5%；95%CI：58.6-66.1%）和≥65岁（63.5%；95%CI：52.2-72.7%）患者移植后5年OS概率也无显著差异（p=0.56）。本研究表明，在新型药物时代，老年多发性骨髓瘤患者接受auto-HCT的安全性和疗效与年轻患者相似。
