Real-world utilisation of ASCT in multiple myeloma (MM): a report from the Australian and New Zealand myeloma and related diseases registry (MRDR)

Bergin, K; Wellard, C; Augustson, B; Cooke, R; Blacklock, H; Harrison, SJ; Ho, J; King, T; Quach, H; Mollee, P; Walker, P; Moore, E; McQuilten, Z; Wood, E; Spencer, A; Australian and New Zealand Myeloma and Related Diseases Registry

Author(s): Bergin, K; Wellard, C; Augustson, B; Cooke, R; Blacklock, H; Harrison, SJ; Ho, J; King, T; Quach, H; Mollee, P; Walker, P; Moore, E; McQuilten, Z; Wood, E; Spencer, A; Australian and New Zealand Myeloma and Related Diseases Registry;
Details: Publication Year 2021-10,Volume 56,Issue #10,Page 2533-2543
Journal Title: Bone Marrow Transplantation
Publication Type: Research article
Abstract: Supported by clinical trial proven survival benefit, clinical guidelines recommend upfront autologous stem cell transplantation (ASCT) for eligible MM patients. However, reported real-world utilisation is lower than expected (40-60%). We reviewed ASCT utilisation, demographics and outcomes for MM patients (</=70 years, >/=12-month follow-up) enroled onto the Australian/New Zealand MRDR from June 2012 to May 2020. In 982 patients (<65 years: 684, 65-70 years: 298), ASCT utilisation was 76% overall (<65 years: 83%, 65-70 years: 61%, front-line therapy: 67%). Non-ASCT recipients were older (median age: 65 years vs 60 years, p < 0.001), had more comorbidities (cardiac disease: 16.9% vs 5.4%, p < 0.001; diabetes: 19.1% vs 7.0%, p < 0.001; renal dysfunction: median eGFR(ml/min): 68 vs 80, p < 0.001), inferior performance status (ECOG >/= 2: 26% vs 13%, p < 0.001) and higher-risk MM (ISS-3: 37% vs 26%, p = 0.009, R-ISS-3 18.6% vs 11.8%, p = 0.051) than ASCT recipients. ASCT survival benefit (median progression-free survival (PFS): 45.3 months vs 35.2 months, p < 0.001; overall survival (OS): NR vs 64.0 months, p < 0.001) was maintained irrespective of age (<65 years: median PFS: 45.3 months vs 37.7 months, p = 0.04, OS: NR vs 68.2 months, p = 0.002; 65-70 years: median PFS: 46.7 months vs 29.2 months, p < 0.001, OS: 76.9 months vs 55.6 months, p = 0.005). This large, real-world cohort reaffirms ASCT survival benefit, including in 'older' patients necessitating well-designed studies evaluating ASCT in 'older' MM to inform evidence-based patient selection.
Keywords: Aged; Australia; Disease-Free Survival; *Hematopoietic Stem Cell Transplantation; Humans; *Multiple Myeloma/therapy; New Zealand; Registries; Retrospective Studies; Transplantation, Autologous; Treatment Outcome
Department(s): Haematology
PubMed ID: 34011965
Publisher's Version: https://doi.org/10.1038/s41409-021-01308-8
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-06-06 07:51:44

Last Modified: 2025-06-06 07:57:04