The impact of age on survival and excess mortality after autologous hematopoietic cell transplantation in newly diagnosed multiple myeloma patients

Abstract

Despite the availability of novel agents, autologous hematopoietic cell transplantation (auto-HCT) remains the standard of care in newly diagnosed multiple myeloma (MM) patients. The impact of age on overall survival (OS), progression-free survival (PFS), relapse incidence, non-relapse mortality (NRM), and excess mortality (taking account of general population mortality) was investigated using information on 61,797 MM patients transplanted between 2013 and 2017. The median age at auto-HCT was 60.8 (range: 18.1–83.2) years of whom 2.0% were 18–39 years, 68.9% 40–64 years, 21.8% 65–69 years, 6.5% 70–74 years, and 0.8% ≥75 years of age, respectively. The corresponding OS probabilities at three years were 85.9%, 82.8%, 81.1%, 78.4%, and 74.8%, respectively (p<0.001). Excess mortality cumulative incidences were 13.1%, 15.0%, 14.6%, 15.0%, and 14.1% at three years, respectively (p=0.67). In multivariable analyses, older age was a significant risk factor for OS, PFS, and NRM but not for excess mortality or relapse risk. Our results indicate that advanced age alone should not preclude the use of auto-HCT in patients with MM.