November 4, 2018Oncology
Multiple myeloma is a form of cancer that occurs due to abnormal and uncontrolled growth of plasma cells in the bone marrow. Some people with multiple myeloma, especially those with early stages of the condition, have no concerning signs or symptoms. When present, the most common symptom is anemia, which can be associated with fatigue and shortness of breath. Other features of the condition may include multiple infections; abnormal bleeding; bone pain; weak and/or easily broken bones; and numbness and/or weakness of the arms and legs. Melphalan, a bifunctional alkylating agent, also known as L-phenylalanine mustard, phenylalanine mustard, L-PAM, or L-sarcolysin, is a phenylalanine derivative of nitrogen mustard, and has been shown to be active against selective human neoplastic diseases.
According to an article published online in Annals of Hematology (27 October 2018), autologous stem cell transplantation (ASCT) is still debatable in treatment of patients over 65 years with multiple myeloma (MM). As a result, a retrospective analysis was performed of newly diagnosed MM patients who underwent ASCT between January 2010 and July 2016. A non-transplanted group with similar clinical characteristics, aged 65-70 years old, diagnosed and treated in the same timeline was used as the control group. A total of 155 patients, 132 of which underwent ASCT (<65 years, n=103, median 56 years; >65 years, n=29, median 67 years) and 23 non-transplanted (median 68 years).
Conditioning consisted of melphalan 200 mg/m2 (MEL200) in younger patients and melphalan 140 mg/m2(MEL140) in half of elderly patients. Results showed that stratifying by age, there were no statistically significant differences concerning transplant-related myelotoxicity and non-hematopoietic toxicity. However, elderly patients conditioned with MEL200 had higher needs of transfusional support, higher grade of mucositis (p=0.028), and more days of intravenous antibiotics (p=0.019) than the elderly transplanted with MEL140. Global transplant-related mortality was 3.8% and survival was not influenced by age. Non-transplanted elderly patients had comparable disease features, and induction response was similar in both groups (before ASCT in the transplanted cohort).
Overall survival (OS) of transplanted elderly patients was superior to non-transplanted (OS, 59 months vs 30 months, p=0.037, and event-free survival (EFS) was 45 months vs 27 months, p=0.014). It was concluded that selected elderly patients when transplanted, have similar disease response and survival as younger patients, and that while a higher dose of melphalan has more toxicity, but it is globally a well-tolerated procedure.