Improved outcome in patients following autologous stem cell transplantation for multiple myeloma in south eastern Norway 2001-2010: a retrospective, population based analysis

Jon-Magnus Tangen; Geir Erland Tjønnfjord; Nina Gulbrandsen; Tobias Gedde-Dahl; Espen Stormorken; Kristina Anderson; Camilla Dao Vo; Fredrik Hellem Schjesvold; For Oslo Myeloma Center

doi:10.1186/s12885-018-4722-x

Improved outcome in patients following autologous stem cell transplantation for multiple myeloma in south eastern Norway 2001-2010: a retrospective, population based analysis

BMC Cancer. 2018 Aug 8;18(1):801. doi: 10.1186/s12885-018-4722-x.

Authors

Affiliations

¹ Department of Acute Medicine, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424, Oslo, Norway. uxjmta@ous-hf.no.
² Department of Haematology, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424, Oslo, Norway. uxjmta@ous-hf.no.
³ Institute of Clinical Medicine, University of Oslo, P.O.Box 1171 Blindern, 0318, Oslo, Norway. uxjmta@ous-hf.no.
⁴ Department of Haematology, Oslo University Hospital, P.O.Box 4950 Nydalen, 0424, Oslo, Norway.
⁵ Institute of Clinical Medicine, University of Oslo, P.O.Box 1171 Blindern, 0318, Oslo, Norway.
⁶ Department of Haematology, Akershus University Hospital, P.O.Box 1000, 1478, Lørenskog, Norway.
⁷ Department of Oncology, Section of Haematology, Østfold Hospital, P.O.Box 300, 1714, Grålund, Norway.
⁸ Department of Medicine, Innlandet Hospital, Gjøvik, P.O.Box 104, 2381, Brummundal, Norway.

Abstract

Background: With the advent of novel drugs improved overall survival in patients with multiple myeloma, including patients who received up-front autologous stem cell transplantation (ASCT), has been reported from several centers. Here we report on overall survival in a population-based cohort of patients receiving ASCT as first line treatment and in whom novel agents were an option for second and later lines of treatment.

Methods: Patients with multiple myeloma ≤ 65 years of age who were considered for ASCT from 01.01.2001-31.06.2005 (period 1) and from 01.07.2005 until 31.12.2009 (period 2) at Oslo University Hospital (OUH) were identified. Relevant data were collected from the patients' medical records.

Results: Altogether, 293/355 patients received ASCT. In all, median OS was 82.9 months in patients ≤ 60 years of age and 59.0 months in patients 61-65 years. For patients ≤ 60 years of age median OS increased from 70.6 months to 87.7 months (p = 0. 22) and median survival after start of second line therapy increased from 34.5 months to 46.5 months (p = 0.015) between the two periods. For patients 61-65 years of age median OS increased from 57.3 months to 61.2 months (p = 0. 87) and median survival after start of second line therapy was practically unchanged (32.6 months vs. 33.1 months (p = 0.97) between the periods. In patients ≤ 60 years of age salvage ASCT was used in 34% of the patients while in patients 61-65 years of age salvage ASCT was used in 7.3% of the patients. The use of salvage ASCT and novel drugs, as well as the number of treatment lines, were higher in patients ≤ 60 years of age and increased during the study period.

Conclusion: In patients ≤ 60 years of age an increased median OS of 17 months between the two periods were noted, but the difference failed to reach statistical significance. However, a statistically significant difference in median survival of 12 months after start of second line therapy was found in this age group, which may be explained by a more active second line treatment. In patients 61-65 years only a slight increase of survival, not statistically significant, was noted between the periods.

Keywords: Autologous stem cell transplantation; Multiple myeloma; Novel drugs; Overall survival.

MeSH terms

Aged
Autografts*
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multiple Myeloma* / epidemiology
Multiple Myeloma* / mortality
Multiple Myeloma* / therapy
Norway / epidemiology
Retrospective Studies
Stem Cell Transplantation*
Treatment Outcome