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( Auner HW , Iacobelli A , Sbianchi G , et al. Melphalan 140 mg/m2 or 200 mg/m2 for autologous transplantation in myeloma: results from the collaboration to collect autologous transplant outcomes in lymphoma and myeloma (CALM) study. A report by the EBMT Chronic Malignancies Working Party. Haematologica. 2018;103(3):514‐521.29217776)
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INTRODUCTIONThe introduction of several new agents, such as proteasome inhibitors (PI), immunomodulatory drugs (IMiDs), and most recently monoclonal antibodies (mAbs) as first‐line treatment in patients with multiple myeloma (MM) has contributed to a better overall survival (OS).1–3 Nevertheless, the conditioning regime with high‐dose melphalan (Mel, 200 mg/m2) followed by autologous stem cell transplantation (ASCT) is the established standard treatment for MM patients younger than 65 years of age and can improve both progression‐free survival (PFS) and OS radically, at least in some subgroups.4 However, the role of ASCT in the treatment of elderly patients is debatable, especially since the introduction of PI, IMiDs, and mABs as first‐line treatments.In MM, Mel is used almost exclusively as conditioning prior to ASCT. Typically, Mel is administered at a fixed dose of 200 mg/m2 (Mel200) except for patients with renal impairment for whom a dose reduction (140 mg/m2) is recommended. The toxicity of Mel in patients older than 65 years might pose a hurdle and is mostly attributed to the anticipated reduction in organ function as well as altered drug metabolism and excretion. Badros et al.5 described a small cohort of elderly patients who received Mel at a dose of either 200 mg/m2 or 140 mg/m2 prior to ASCT. The
European Journal of Haematology – Wiley
Published: Dec 1, 2022
Keywords: aged; multiple myeloma; progression‐free survival; stem cell transplantation
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