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Dos Santos, David M. Cordas; Saliba, Rima M.; Patel, Romil; Bashir, Qaiser; Saini, Neeraj; Hosing, Chitra; Kebriaei, Partow; Khouri, Issa F.; Nieto, Yago; Popat, Uday; Ahmed, Haris; Lee, Hans C.; Manasanch, Elisabet E.; Patel, Krina K.; Thomas, Sheeba K.; Weber, Donna M.; Orlowski, Robert Z.; Champlin, Richard E.; Qazilbash, Muzaffar H. (2020): Age Is a Prognostic Factor for the Overall Survival of Patients with Multiple Myeloma Undergoing Upfront Autologous Hematopoietic Stem Cell Transplantation. In: Biology of Blood and Marrow Transplantation, Vol. 26, No. 6: pp. 1077-1083
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In this retrospective analysis, we evaluated the impact of age on the outcome of patients with multiple myeloma who received an autologous hematopoietic stem cell transplantation (auto-HCT) at our institution. A total of 1128 patients were divided into the older (>70 years;182 [16%]) and the younger (<= 70 years;946 [84%]) groups. Compared with the younger cohort, older patients had a higher International Staging System (ISS) stage (ISS-II, 57 [31%] versus 215 [23%];ISS-III, 52 [28%] versus 211 [22%];P = .01), higher use of reduced-dose melphalan as a conditioning regimen (140 mg/m(2), 59 [32%] versus 29 [3%];P < .001), and a higher comorbidity index (median, 3 versus 2;P = .01). Nonrelapse mortality at 1 year after auto-HCT was significantly higher in older patients (7 [4%] versus 9 [1%];hazard ratio [HR], 4.1;P = .005). Complete remission rates after auto-HCT for the older and the younger groups were 41% and 46%, respectively. With a median follow-up of 52 months, the 5-year progression-free survival (PFS) was 24% (95% confidence interval [CI], 17% to 32%) and 37% (95% CI, 33% to 40%) in the older and younger groups, respectively (HR, 1.3;P = .02). Five-year OS for the older and younger groups was 56% (95% CI, 47% to 64%) and 73% (95% CI, 70% to 76%;P < .001), respectively. Older age emerged as one of the predictors of shorter OS but not PFS in the multivariate classification and regression tree analysis. In conclusion, age >= 70 years was associated with shorter PFS and OS in patients with multiple myeloma who underwent an auto-HCT.