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The real world effectiveness of hematopoietic transplant among elderly individuals with multiple myeloma. J Natl Cancer Inst 2015 Aug;107(8)

Date

05/30/2015

Pubmed ID

26023094

Pubmed Central ID

PMC4554189

DOI

10.1093/jnci/djv139

Abstract

BACKGROUND: Hematopoietic stem cell transplant (HSCT) is the preferred treatment for young patients with multiple myeloma (MM), but for older adults there is limited evidence on its effectiveness from clinical trials.

METHODS: We used the Surveillance, Epidemiology, and End Results (SEER)-Medicare database to identify individuals age 66 years and older with multiple myeloma (MM) who were diagnosed between 2000 and 2007. We used traditional multivariable analysis, propensity score-based analysis, coarsened exact matching, and an instrumental variable analysis to compare survival for individuals who did or did not receive an hematopoietic stem cell transplant. Survival was measured by Cox proportional hazard models. All statistical tests were two-sided.

RESULTS: Patients with MM receiving an HSCT were more likely to be white, married, younger, and have fewer comorbidities. Results from all analytic techniques consistently showed that HSCT statistically significantly improved survival, with hazard ratios (HRs) ranging from 0.531 to 0.608 (traditional multivariable analysis: HR = 0.582, 95% confidence interval [CI] = 0.49 to 0.69; propensity score analysis: HR = 0.572, 95% CI = 0.46 to 0.72; coarsened exact matching: HR = 0.608, 95% CI = 0.49 to 0.76; instrumental variable analysis: HR = 0.531, 95% CI = 0.36 to 0.78, all P values ≤ .001).

CONCLUSIONS: Overall survival has increased among patients with MM receiving HSCT. This finding was consistent across statistical methods, indicating robustness of our findings.

Author List

Winn AN, Shah GL, Cohen JT, Lin PJ, Parsons SK

Author

Aaron Winn PhD Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Aged, 80 and over
Comorbidity
Cost-Benefit Analysis
Female
Hematopoietic Stem Cell Transplantation
Humans
Kaplan-Meier Estimate
Male
Multiple Myeloma
Multivariate Analysis
Odds Ratio
Propensity Score
Proportional Hazards Models
Quality-Adjusted Life Years
SEER Program
Treatment Outcome
United States
jenkins-FCD Prod-399 190a069c593fb5498b7fcd942f44b7bc9cdc7ea1