In the study cohort, achievement of at least VGPR before Auto-SCT was associated with marginally improved PFS and OS compared with less than VGPR before SCT (for PFS: median, 45.2 vs 31.5 months; P=0.05) (for OS: median, 9.3 vs 5.8 years; P=0.13). (2020), Current Research in Translational Medicine Nordic Myeloma Study Group. In a multivariate analysis, shorter PFS was predicted by male sex, transplant period 1998–2006, relapsed disease state and attainment of less than sCR after transplant. Characteristics of patients in the younger and older cohorts were compared using the χ2-test for categorical variables and the Kruskal–Wallis test for continuous variables (Table 1). First, as in other transplant studies, the older patients undergoing AuSCT represent a select group of individuals with satisfactory organ function and performance status; no data are available on the proportion of older myeloma patients ineligible for this procedure. (2020), Current Research in Translational Medicine Maloney DG, Sahebi F, Stockerl-Goldstein KE et al. For mobilization, the CD34+ yield with G-CSF/plerixafor was similar to that with G-CSF alone (6.23 × 106/kg vs 5.66 × 106/kg). J Natl Cancer Inst 2015; 107: 1–6. The number of apheresis sessions was lower in 2007–2015 compared with 1998–2006 (mean, 2.1 vs 2.6 days; P=0.02). The role of autologous stem cell transplantation (AuSCT) in older multiple myeloma patients is unclear. Kumar SK, Dingli D, Lacy MQ, Dispenzieri A, Hayman SR, Buadi FK et al.

All statistical analysis was performed with JMP software (SAS Institute Inc.) with statistical significance set at P<0.05. In all, 75% of the older patients were 60–64 years of age, while 25% were ⩾65 years of age, including three patients ⩾70 years. Most cases resolved with medical treatment. Mobilization and transplant management at our institution have been previously described.14, 15 All mobilizations were performed with G-CSF SC (10 μg/kg/day). One patient, conditioned with full-dose melphalan, died of CMV pneumonitis on day 25. The causes of death in older patients were as follows: primary disease in 40 (80%), infection in three (6%), organ failure in three (6%) and other causes in four (8%). Google Scholar. Drug therapy, such as amiodarone or β-blockers, is probably warranted for prevention in high-risk patients, but the appropriate selection for this intervention needs to be clarified. Participating centers are required to report all transplants consecutively; compliance is monitored by on-site audits. Age at transplantation and outcome after autologous stem cell transplantation in elderly patients with multiple myeloma. The melphalan dose was adjusted because of reduced eGFR in only 30% of patients. Patients were required to have received hematopoietic stem cell grafts (blood with or without bone marrow). The χ2 test and Fisher's exact test were used to compare differences between continuous variables, and the Wilcoxon signed rank test was used for nonparametric group comparisons. Partial response (PR) required a ⩾50% decrease in paraprotein level and/or ⩾90% decrease in light chain excretion or a level less than 200 mg/day in the absence of other signs of disease progression, which was also maintained for a minimum of 6 weeks. Mayo Clin Proc 2008; 83: 1131–1138. Despite the lack of randomized data for Auto-SCT in elderly patients, its application in the elderly has increased because of the growing experience with Auto-SCT in general, improved supportive care and better stem cell mobilization.13, 17 Another important factor is the introduction of reduced-dose conditioning, shown to be better tolerated in elderly patients and still yield beneficial results, comparable to conditioning with melphalan 200 mg/m2.1. Frailty screening methods for predicting outcome of a comprehensive geriatric assessment in elderly patients with cancer: a systematic review. Bone Marrow Transplant 2015; 50: 95–99. Six patients had venous thromboembolic events, and all were treated medically. The number of transfusions did not differ between full and reduced conditioning doses. Passweg JR, Baldomero H, Peters C, Gaspar HB, Cesaro S, Dreger P et al. Estimation of failure probabilities in the presence of competing risks: new representations of old estimators.

Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study.

Stem cell collection was performed with G-CSF alone in 40% of patients, G-CSF and plerixafor in 39% of patients, and G-CSF in combination with CY in 21% of patients.

In addition, while infection control is better in elderly patients in recent years, the rate of cardiac arrhythmia remains high and unchanged over time, raising the need for preventive measures. Palumbo A, Bringhen S, Mateos MV, Larocca A, Facon T, Kumar SK et al. Fukuoka Blood and Marrow Transplant Group (FBMTG). Investigation of other risk factors for arrhythmia is warranted to promote preventive measures in a more focused manner. PubMed Central  From the institutional transplant registry, 207 consecutive MM patients who were 70 years or older at Auto-SCT (study cohort) were identified. Arrhythmias occurred at a median of 8 days (IQR, 4–10 days) after stem cell infusion. Palumbo A, Bringhen S, Bertola A, Cavallo F, Falco P, Massaia M et al. ISSN 1476-5365 (online), Autologous stem cell transplant for multiple myeloma patients 70 years or older, Serum electrolyte dynamics in multiple myeloma patients undergoing autologous haematopoietic stem cell transplantation, Autologous stem cell transplantation is safe in selected elderly multiple myeloma patients, Tolerability of high dose chemotherapy and autologous stem cell transplantation in elderly patients with multiple myeloma: A single-center retrospective analysis, Outcomes with autologous stem cell transplant vs. non-transplant therapy in patients 70 years and older with multiple myeloma, Electrophysiology Translational Considerations in Cardio-Oncology: QT and Beyond. Lenhoff S, Hjorth M, Holmberg E et al. Br J Haematol 1999; 102: 495–502. -, Bone Marrow Transplant. More recently, this group has extended their analysis to 70 recipients of AuSCT, who were ⩾70 years of age (range 72–82.6). The real world effectiveness of hematopoietic transplant among elderly individuals with multiple myeloma. volume 51, pages1449–1455(2016)Cite this article. Ann Oncol 2002; 13: 1116–1119. Patients were admitted for uncontrolled fever, poor intake, intractable pain from mucositis that necessitated parenteral medication, decrease in performance status or arrhythmia. Blood 2000; 95: 7–11. The proportion of patients with a β2-microglobulin >3.5 was similar in the two groups. Article  (2020), Bone Marrow Transplantation

Atrial fibrillation following autologous stem cell transplantation in patients with multiple myeloma: incidence and risk factors. Improved post-AuSCT approaches involving newer targeted therapies,22 immunotherapy23 or perhaps reduced intensity allogeneic transplants may help in this regard.24. COVID-19 is an emerging, rapidly evolving situation. Each model contained the main effect (age at transplant: <60 vs ⩾60 years). Palumbo A, Triolo S, Argentino C et al. Only 12% of patients who had arrhythmia during transplant had a prior history of a similar event.

Gooley A, Leisenring W, Crowley J et al. Evaluation of the feasibility and efficacy of autologous stem cell transplantation in elderly patients with multiple myeloma. Google Scholar. N Engl J Med 1996; 335: 91–97. Our study was not able to confirm the prognostic utility of the pre-AuSCT β2-microglobulin level or cytogenetics due to the constraints of a registry analysis, as this information was available for only 52 and 15% of patients, respectively. The proportion of Auto-SCT in the older patients increased from 7.8% of all transplants in 1998–2006 to 12.9% in 2007–2015. Kuruvilla J, Shepherd JD, Sutherland HJ, Nevill TJ, Nitta J, Le A, Forrest DL, Hogge DE, Lavoie JC, Nantel SH, Toze CL, Smith CA, Barnett MJ, Song KW. AuSCT has become the standard of care for newly diagnosed younger myeloma patients. Blade J, Samson D, Reece D et al. Another consideration relates to the sample size available for analysis. No difference was noted in the rate of arrhythmia between the two periods (P=0.79). However, the median age of patients with this disease is approximately 65 years, and there is considerable interest in the outcome of older patients who undergo AuSCT. Blood 1997; 89: 789–793. In a univariate analysis, inferior OS was associated with the following variables: male sex, transplant period 1998–2006, ISS stage III (vs ISS stages I or II), achievement of less than VGPR before Auto-SCT and achievement of less than sCR after Auto-SCT.