Autologous stem cell transplantation is safe in selected elderly multiple myeloma patients

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Objectives ASCT is currently the “gold standard” first‐line treatment for multiple myeloma patients younger than 65 years old, and limited data on efficacy and safety in older patients are available. Methods We retrospectively analyzed a cohort of 83 newly diagnosed multiple myeloma patients aged 65 or older. All patients were evaluated for fitness at diagnosis and after bortezomib‐based induction treatment. Results and conclusions All patients collected an adequate PBSC graft, mainly after G‐CSF plus cyclophosphamide; a median of 6.47 × 106/kg CD34 + cells was collected. The conditioning regimen consisted of melphalan 100, 140 and 200 mg/m2 in 40, 15 and 28 patients, respectively. Median time to neutrophils’ and platelets’ recovery was 11 and 12 days, respectively. Adverse events of any grade were referred by 40% of patients. The overall response rate was 93%, CR/sCR were 39%. Median PFS was 35 months; median OS was not reached. In our study cohort, the achievement of at least VGPR after induction therapy and the obtainment of CR/sCR after ASCT are the only parameters that were associated with an improved PFS. ASCT is an effective and safe first‐line treatment approach, a careful patients selection reduce the toxicity of the procedure.