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Autologous stem cell transplant blog12/2/2023 ![]() Patients of different ages achieved a similar depth of response at 100 days after ASCT ( Table 1) with an improvement in response compared to the end of induction seen in 863 of 1,366 (63.2%) patients overall (62.7% of those aged <65, 64.5% of those aged 65-69 and 63.6% of those aged over 70). Response to transplant, PFS and OS outcomes for patients of different ages within the TE pathway who underwent ASCT were compared. This appeared to be due to both an increased incidence of elevated serum creatinine (>200 mmol/L) in the older age groups and the systematic use of the lower dose for older patients in some centers. For the first set of analyses patients in the TE pathway were categorized by age group 70 years. ![]() This is a retrospective, exploratory analysis of data from the Myeloma XI trial. There was no recommendation to reduce the melphalan dose based on age in the protocol. ASCT in older patients was well tolerated with no difference in morbidity or mortality between patients aged 500 μmol/L or urine output 200 mmol/L were to receive 140 mg/m 2. Older patients within the transplant-eligible pathway were less likely to undergo stem cell harvest at the end of induction than younger patients and of those patients undergoing ASCT there was a reduction in progression-free survival associated with increasing age. Data from the UK NCRI Myeloma XI trial, a large phase III randomized controlled trial with pathways for transplant-eligible and -ineligible patients, were used in an exploratory analysis to examine the efficacy and toxicity of ASCT in older patients including an analysis using an age-matched population to compare outcomes for patients receiving similar induction therapy with or without ASCT. In real-world practice stem cell transplants are not restricted to those aged under 65 and clinicians decide on transplant eligibility based on a patient’s fitness rather than a strict age cut-off. In recent clinical trials comparing ASCT to delayed ASCT, patients aged over 65 were excluded. Autologous stem cell transplant (ASCT) remains the standard of care for consolidation after induction therapy for eligible patients with newly diagnosed myeloma. ![]()
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