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

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 ≤65years 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 82.9months in patients ≤60years of age and 59.0months in patients 61-65years. For patients ≤60years of age median OS increased from 70.6months to 87.7months (p=0. 22) and median survival after start of second line therapy increased from 34.5months to 46.5months (p=0.015) between the two periods. For patients 61-65years of age median OS increased from 57.3months to 61.2months (p=0. 87) and median survival after start of second line therapy was practically unchanged (32.6months vs. 33.1months (p=0.97) between the periods. In patients ≤60years of age salvage ASCT was used in 34% of the patients while in patients 61-65years 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 ≤60years of age and increased during the study period. Conclusion: In patients ≤60years of age an increased median OS of 17months between the two periods were noted, but the difference failed to reach statistical significance. However, a statistically significant difference in median survival of 12months 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 61-65years only a slight increase of survival, not statistically significant, was noted between the periods.