Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Plasma Cell Disorders

Trends in autologous hematopoietic cell transplantation for multiple myeloma in Europe: increased use and improved outcomes in elderly patients in recent years

Bone Marrow Transplantation volume 50, pages 209–215 (2015)Cite this article

Subjects

Abstract

Autologous hematopoietic cell transplantation (AHCT) is a standard of care in multiple myeloma (MM) patients aged <65 years. To understand age-related trends in utilisation and outcome of AHCT, we analysed 53 675 MM patients who underwent a first AHCT in 31 European countries between 1991 and 2010. The number of patients undergoing AHCT increased for all age groups (<40, 40–49, 50–59, 60–64, 65–69 and ⩾70 years) throughout the observation period. The highest increase was observed for patients aged ⩾65 years, who accounted for 3% of AHCTs in 1991–1995 and for 18.8% of AHCTs in 2006–2010. Risk factors associated with survival over the entire observation period (P<0.001) were calendar period, remission status at AHCT, gender, disease duration before AHCT and age. Survival improved considerably more in older than in younger patients in recent years. In 2006–2010, median 2- and 5-year post-transplant survival ranged from 85.9 and 61.5% in patients <40 years to 80.2 and 49.7% in those ⩾70 years. All-cause day-100 mortality decreased throughout the observation period to ⩽2.4% for all age groups in 2006–2010. The results of this study demonstrate increased utilisation and safety of AHCT with improved post-transplant survival particularly in elderly MM patients in recent years in Europe.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Kyle RA, Rajkumar SV . Epidemiology of the plasma-cell disorders. Best Pract Res Clin Haematol 2007; 20: 637–664.

    Article  CAS  PubMed  Google Scholar 

  2. Parkin DM, Bray F, Ferlay J, Pisani P . Global cancer statistics, 2002. CA Cancer J Clin 2005; 55: 74–108.

    Article  PubMed  Google Scholar 

  3. Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC . Multiple myeloma. Lancet 2009; 374: 324–339.

    Article  PubMed  Google Scholar 

  4. Sirohi B, Powles R . Epidemiology and outcomes research for MGUS, myeloma and amyloidosis. Eur J Cancer 2006; 42: 1671–1683.

    Article  PubMed  Google Scholar 

  5. McElwain TJ, Powles RL . High-dose intravenous melphalan for plasma-cell leukaemia and myeloma. Lancet 1983; 2: 822–824.

    Article  CAS  PubMed  Google Scholar 

  6. Gore ME, Selby PJ, Viner C, Clark PI, Meldrum M, Millar B et al. Intensive treatment of multiple myeloma and criteria for complete remission. Lancet 1989; 2: 879–882.

    Article  CAS  PubMed  Google Scholar 

  7. Jagannath S, Barlogie B, Dicke K, Alexanian R, Zagars G, Cheson B et al. Autologous bone marrow transplantation in multiple myeloma: identification of prognostic factors. Blood 1990; 76: 1860–1866.

    CAS  PubMed  Google Scholar 

  8. Barlogie B, Alexanian R, Dicke KA, Zagars G, Spitzer G, Jagannath S et al. High-dose chemoradiotherapy and autologous bone marrow transplantation for resistant multiple myeloma. Blood 1987; 70: 869–872.

    CAS  PubMed  Google Scholar 

  9. Barlogie B, Hall R, Zander A, Dicke K, Alexanian R . High-dose melphalan with autologous bone marrow transplantation for multiple myeloma. Blood 1986; 67: 1298–1301.

    CAS  PubMed  Google Scholar 

  10. Fermand JP, Levy Y, Gerota J, Benbunan M, Cosset JM, Castaigne S et al. Treatment of aggressive multiple myeloma by high-dose chemotherapy and total body irradiation followed by blood stem cells autologous graft. Blood 1989; 73: 20–23.

    CAS  PubMed  Google Scholar 

  11. Attal M, Harousseau JL, Stoppa AM, Sotto JJ, Fuzibet JG, Rossi JF et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma. Intergroupe Francais du Myelome. N Engl J Med 1996; 335: 91–97.

    Article  CAS  PubMed  Google Scholar 

  12. Child JA, Morgan GJ, Davies FE, Owen RG, Bell SE, Hawkins K et al. High-dose chemotherapy with hematopoietic stem-cell rescue for multiple myeloma. N Engl J Med 2003; 348: 1875–1883.

    Article  CAS  PubMed  Google Scholar 

  13. Ozaki S, Harada T, Saitoh T, Shimazaki C, Itagaki M, Asaoku H et al. Survival of multiple myeloma patients aged 65-70 years in the era of novel agents and autologous stem cell transplantation. A multicenter retrospective collaborative study of the japanese society of myeloma and the european myeloma network. Acta Haematol 2014; 132: 211–219.

    Article  PubMed  Google Scholar 

  14. Jantunen E, Kuittinen T, Penttila K, Lehtonen P, Mahlamaki E, Nousiainen T . High-dose melphalan (200 mg/m2) supported by autologous stem cell transplantation is safe and effective in elderly (&gt;or=65 years) myeloma patients: comparison with younger patients treated on the same protocol. Bone Marrow Transplant 2006; 37: 917–922.

    Article  CAS  PubMed  Google Scholar 

  15. Kumar SK, Dingli D, Lacy MQ, Dispenzieri A, Hayman SR, Buadi FK et al. Autologous stem cell transplantation in patients of 70 years and older with multiple myeloma: Results from a matched pair analysis. Am J Hematol 2008; 83: 614–617.

    Article  PubMed  Google Scholar 

  16. Gay F, Magarotto V, Crippa C, Pescosta N, Guglielmelli T, Cavallo F et al. Bortezomib induction, reduced-intensity transplantation, and lenalidomide consolidation-maintenance for myeloma: updated results. Blood 2013; 122: 1376–1383.

    Article  CAS  PubMed  Google Scholar 

  17. Qazilbash MH, Saliba RM, Hosing C, Mendoza F, Qureshi SR, Weber DM et al. Autologous stem cell transplantation is safe and feasible in elderly patients with multiple myeloma. Bone Marrow Transplant 2007; 39: 279–283.

    Article  CAS  PubMed  Google Scholar 

  18. Bashir Q, Shah N, Parmar S, Wei W, Rondon G, Weber DM et al. Feasibility of autologous hematopoietic stem cell transplant in patients aged &gt;/=70 years with multiple myeloma. Leuk Lymphoma 2012; 53: 118–122.

    Article  CAS  PubMed  Google Scholar 

  19. Badros A, Barlogie B, Siegel E, Morris C, Desikan R, Zangari M et al. Autologous stem cell transplantation in elderly multiple myeloma patients over the age of 70 years. Br J Haematol 2001; 114: 600–607.

    Article  CAS  PubMed  Google Scholar 

  20. Palumbo A, Bringhen S, Petrucci MT, Musto P, Rossini F, Nunzi M et al. Intermediate-dose melphalan improves survival of myeloma patients aged 50 to 70: results of a randomized controlled trial. Blood 2004; 104: 3052–3057.

    Article  CAS  PubMed  Google Scholar 

  21. Merz M, Neben K, Raab MS, Sauer S, Egerer G, Hundemer M et al. Autologous stem cell transplantation for elderly patients with newly diagnosed multiple myeloma in the era of novel agents. Ann Oncol 2014; 25: 189–195.

    Article  CAS  PubMed  Google Scholar 

  22. Gertz MA, Lacy MQ, Dispenzieri A, Hayman SR, Kumar S, Leung N et al. Impact of age and serum creatinine value on outcome after autologous blood stem cell transplantation for patients with multiple myeloma. Bone Marrow Transplant 2007; 39: 605–611.

    Article  CAS  PubMed  Google Scholar 

  23. Facon T, Mary JY, Hulin C, Benboubker L, Attal M, Pegourie B et al. Melphalan and prednisone plus thalidomide versus melphalan and prednisone alone or reduced-intensity autologous stem cell transplantation in elderly patients with multiple myeloma (IFM 99-06): a randomised trial. Lancet 2007; 370: 1209–1218.

    Article  CAS  PubMed  Google Scholar 

  24. Blade J, Rosinol L, Cibeira MT, Rovira M, Carreras E . Hematopoietic stem cell transplantation for multiple myeloma beyond 2010. Blood 2010; 115: 3655–3663

    Article  CAS  PubMed  Google Scholar 

  25. Giralt S, Stadtmauer EA, Harousseau JL, Palumbo A, Bensinger W, Comenzo RL et al. International myeloma working group (IMWG) consensus statement and guidelines regarding the current status of stem cell collection and high-dose therapy for multiple myeloma and the role of plerixafor (AMD 3100). Leukemia 2009; 23: 1904–1912.

    Article  CAS  PubMed  Google Scholar 

  26. Moreau P, Avet-Loiseau H, Harousseau JL, Attal M . Current trends in autologous stem-cell transplantation for myeloma in the era of novel therapies. J Clin Oncol 2011; 29: 1898–1906.

    Article  PubMed  Google Scholar 

  27. Palumbo A, Sezer O, Kyle R, Miguel JS, Orlowski RZ, Moreau P et al. International Myeloma Working Group guidelines for the management of multiple myeloma patients ineligible for standard high-dose chemotherapy with autologous stem cell transplantation. Leukemia 2009; 23: 1716–1730.

    Article  CAS  PubMed  Google Scholar 

  28. Brenner H, Gondos A, Pulte D . Recent major improvement in long-term survival of younger patients with multiple myeloma. Blood 2008; 111: 2521–2526.

    Article  CAS  PubMed  Google Scholar 

  29. Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK et al. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008; 111: 2516–2520.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Turesson I, Velez R, Kristinsson SY, Landgren O . Patterns of improved survival in patients with multiple myeloma in the twenty-first century: a population-based study. J Clin Oncol 2010; 28: 830–834.

    Article  PubMed  Google Scholar 

  31. Pulte D, Gondos A, Brenner H . Improvement in survival of older adults with multiple myeloma: results of an updated period analysis of SEER data. Oncologist 2011; 16: 1600–1603.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Schaapveld M, Visser O, Siesling S, Schaar CG, Zweegman S, Vellenga E . Improved survival among younger but not among older patients with multiple myeloma in the Netherlands, a population-based study since 1989. Eur J Cancer 2010; 46: 160–169.

    Article  PubMed  Google Scholar 

  33. Pozzi S, Marcheselli L, Bari A, Liardo EV, Marcheselli R, Luminari S et al. Survival of multiple myeloma patients in the era of novel therapies confirms the improvement in patients younger than 75 years: a population-based analysis. Br J Haematol 2013; 163: 40–46.

    Article  PubMed  Google Scholar 

  34. Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S et al. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia 2014; 28: 1122–1128.

    Article  CAS  PubMed  Google Scholar 

  35. Crawley C, Iacobelli S, Bjorkstrand B, Apperley JF, Niederwieser D, Gahrton G . Reduced-intensity conditioning for myeloma: lower nonrelapse mortality but higher relapse rates compared with myeloablative conditioning. Blood 2007; 109: 3588–3594.

    Article  CAS  PubMed  Google Scholar 

  36. Blade J, Samson D, Reece D, Apperley J, Bjorkstrand B, Gahrton G et al. Criteria for evaluating disease response and progression in patients with multiple myeloma treated by high-dose therapy and haemopoietic stem cell transplantation. Myeloma Subcommittee of the EBMT. European Group for Blood and Marrow Transplant. Br J Haematol 1998; 102: 1115–1123.

    Article  CAS  PubMed  Google Scholar 

  37. Durie BG, Harousseau JL, Miguel JS, Blade J, Barlogie B, Anderson K et al. International uniform response criteria for multiple myeloma. Leukemia 2006; 20: 1467–1473.

    Article  CAS  PubMed  Google Scholar 

  38. McCarthy PL Jr, Hahn T, Hassebroek A, Bredeson C, Gajewski J, Hale G et al. Trends in use of and survival after autologous hematopoietic cell transplantation in North America, 1995-2005: significant improvement in survival for lymphoma and myeloma during a period of increasing recipient age. Biol Blood Marrow Transplant 2013; 19: 1116–1123.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Costa LJ, Zhang MJ, Zhong X, Dispenzieri A, Lonial S, Krishnan A et al. Trends in utilization and outcomes of autologous transplantation as early therapy for multiple myeloma. Biol Blood Marrow Transplant 2013; 19: 1615–1624.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Levine MN, Julian JA . Registries that show efficacy: good, but not good enough. J Clin Oncol 2008; 26: 5316–5319.

    Article  PubMed  Google Scholar 

  41. Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S et al. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia 2013; 28: 1122–1128.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine, Imperial College London, London, UK,

    H W Auner & R Szydlo

  2. Leiden University Medical Centre, Leiden, The Netherlands

    J Hoek

  3. Medizinische Klinik V, University Hospital Heidelberg, Heidelberg, Germany

    H Goldschmidt & S Schönland

  4. Institut Paoli Calmette, Marseille, France

    A M Stoppa

  5. The Royal Marsden Hospital, London, UK

    G J Morgan

  6. Centre Hospitalier Universitaire, Nantes, France

    P Moreau

  7. Centre Hospitalier Universitaire, Toulouse, France

    M Attal

  8. Centre Hospitalier Universitaire, Bordeaux, France

    G Marit

  9. Nottingham City Hospital, Nottingham, UK

    N Russell

  10. Sahlgrenska University Hospital, Göteborg, Sweden

    M Brune

  11. St James’s Institute of Oncology, Leeds, UK

    G Cook

  12. Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands,

    P Sonneveld

  13. Department of Haematology, Hopital Saint-Antoine, Paris, France

    L Garderet

  14. Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

    N Kröger

Authors
  1. H W Auner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Szydlo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Hoek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H Goldschmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A M Stoppa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G J Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P Moreau
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M Attal
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. G Marit
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. N Russell
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M Brune
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. G Cook
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. P Sonneveld
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. S Schönland
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. L Garderet
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. N Kröger
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Plasma Cell Disorders Subcommittee of the European Society for Blood and Marrow Transplantation (EBMT) Chronic Malignancies Working Party

Corresponding author

Correspondence to H W Auner.

Ethics declarations

Competing interests

HG has been a consultant for Janssen, Celgene, Novartis, Onyx and Millennium, has received honoraria from Janssen, Celgene, Novartis, Onyx, Chugai and Millennium, and has received research funding from Janssen, Celgene, Novartis and Chugai. GM has received remuneration from Janssen and Celgene. PM has been a consultant for and received honoraria from Celgene, Janssen, and Millenium. SS has received honoraria from Celgene and Janssen and research funding from Celgene. PS has received honoraria and research funding from Celgene, Janssen and Onyx. The remaining authors declare no conflict of interest.

Additional information

Author Contributions

HWA designed the research, analysed and interpreted the data and wrote the manuscript. RS analysed the data and commented on the manuscript. JH analysed the data. SS, LG, and NK commented on the research design, interpreted the data, provided patients and commented on the manuscript. HG, AMS, GJM, PM, MA, GM, NR, MB, GC and PS interpreted the data, provided patients and commented on the manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Auner, H., Szydlo, R., Hoek, J. et al. Trends in autologous hematopoietic cell transplantation for multiple myeloma in Europe: increased use and improved outcomes in elderly patients in recent years. Bone Marrow Transplant 50, 209–215 (2015). https://doi.org/10.1038/bmt.2014.255

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2014.255

This article is cited by

Search

Advanced search

Quick links