Exploring the Role of Stem Cell Transplant for Patients With Myeloma Older Than 65

At the 2024 Great Debates & Updates (GDU) in Hematologic Malignancies meeting in New York, New York, David Siegel, MD, PhD, Hackensack Meridian Health, Hackensack, New Jersey, discusses the role of stem cell transplant for patients with myeloma over age 65 and argues that it is a viable treatment option for this patient population.

Transcript:

Hi, I'm David Siegel. I'm the chief of the Myeloma division at the John Theurer Cancer Center, which is at Hackensack University Medical Center in Hackensack, New Jersey. My topic at the Great Debates [and Updates in Hematologic Malignancies] meeting was whether stem cell transplantation [is] a legitimate thing to offer [to] patients over the age of 65.

I think there [are] a number of points to be made in regards to this. Number 1, the median age of diagnosis for myeloma patient is about 70. So, when we say we're not going to transplant people---[with] high-dose, autologous, peripheral stem cell transplants---that we're not going to offer them to people over the age of 65, we're talking about most myeloma patients.

I think there [were] a number of points to be made. Number 1, there have been innumerable studies dating back decades now in many different eras, and none of which have shown that age is a dominant prognostic factor for outcomes after transplant.

So, when we say this, we're talking about a number of issues. Number 1: efficacy. Are older patients less likely to respond? And are their responses likely to be shorter? The answer to both of those questions is there is no difference between patients under the age of 65 and patients over the age of 65. So, the response rates are about the same. The durability of those responses is about the same.

Now, obviously, as we get older, our risk of dying from other causes goes up, so overall survival may be slightly less. But the reality of it is there is no statistically significant difference in even overall survival for patients under and over the age of 65. So, number 1: efficacy. Efficacy seems to be the same whether you're older or younger.

[Number 2:] toxicities. There's not a dramatic difference in toxicities in patients over or under the age of 65. Perhaps, as important as any of those, is a quality-of-life argument. We have a study [on] that here at Hackensack, and it has been studied in any number of other studies in other venues in which there is not a significant deterioration in quality-of-life relationship [when] being transplanted over the age of 65. In fact, the most dangerous drug that we use in the management of myeloma are corticosteroids---dexamethasone, prednisone, [and] drugs like that. Transplant offers an opportunity to not have to be exposed to those kinds of drugs indefinitely.

Again, I think that the point was made that age has not been objectively demonstrated to impact outcome[s] related to transplant. The way I broke this up in the talk was also to look at the different eras. When transplant first started being done, there [were] really no alternative therapies. We didn’t really have very good drugs, and then, there was really no choice. You either got transplanted or you died relatively quickly from your myeloma. Well, we've evolved much better therapies, and those therapies haven't replaced stem cell transplants.

So, even in this era where we have many other effective drugs for managing myeloma, the role of high-dose therapy--- of high-dose stem cell rescue---remains a clear one. I think [those are] really the main take-home points.

Source:

Siegel D. Debate - Should Stem Cell Transplant Be Offered to Patients over 65? YES. Presented at the Great Debates and Updates in Hematologic Malignancies Meeting; April 5-6, 2024; New York, New York.