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Purpose <p>The optimal treatment strategy for patients aged 65–75&#xa0;years with multiple myeloma (MM) remains undefined, as most clinical trials involving transplant-eligible patients have excluded this subgroup. We investigated the real-world treatment patterns, outcomes, and clinical impact of autologous stem cell transplantation (ASCT) and quadruplet therapy in this population.</p> Methods <p>We retrospectively analyzed 561 patients aged 65–75&#xa0;years with newly diagnosed MM treated between 2015 and 2023 at two tertiary centers. Patients were stratified by age (&lt; 70 vs. ≥ 70&#xa0;years) and ASCT status.</p> Results <p>The use of quadruplet regimens and ASCT has increased markedly since 2021. Among patients aged 65–69&#xa0;years, ASCT was associated with improved progression-free survival (PFS) (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.27–0.53; <i>P</i> &lt; 0.001) and overall survival (HR, 0.30; 95% CI, 0.17–0.55; <i>P</i> &lt; 0.001). In those aged 70–75&#xa0;years, quadruplet therapy was independently associated with superior PFS (HR, 0.29; 95% CI, 0.12–0.73; <i>P</i> = 0.009). Similarly, in non-transplant recipients, quadruplet therapy remained a favorable predictor of PFS (HR, 0.40; 95% CI, 0.19–0.87; <i>P</i> = 0.021).</p> Conclusion <p>Intensive treatment strategies—including ASCT and quadruplet therapy—are both feasible and beneficial for selected patients with MM aged ≥ 65&#xa0;years. Therefore, chronological age alone should not be used to determine treatment eligibility. These findings provide real-world evidence that supports a shift toward individualized fitness-based treatment approaches to optimize outcomes in older patients with MM.</p>

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Nuanced treatment decision in newly diagnosed multiple myeloma patients aged 65–75 years: a real-world study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月24日

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  • Naryllae Lee,
  • Seoyeon Kim,
  • Yugyeong Lee,
  • Sin Young Park,
  • Hyunsoo Cho,
  • Ja Min Byun,
  • Youngil Koh,
  • Junshik Hong,
  • Dong-Yeop Shin,
  • Chang-Ki Min,
  • Seonggyu Byeon,
  • Sung-Soo Park,
  • Dong Hyun Kim

摘要

Purpose

The optimal treatment strategy for patients aged 65–75 years with multiple myeloma (MM) remains undefined, as most clinical trials involving transplant-eligible patients have excluded this subgroup. We investigated the real-world treatment patterns, outcomes, and clinical impact of autologous stem cell transplantation (ASCT) and quadruplet therapy in this population.

Methods

We retrospectively analyzed 561 patients aged 65–75 years with newly diagnosed MM treated between 2015 and 2023 at two tertiary centers. Patients were stratified by age (< 70 vs. ≥ 70 years) and ASCT status.

Results

The use of quadruplet regimens and ASCT has increased markedly since 2021. Among patients aged 65–69 years, ASCT was associated with improved progression-free survival (PFS) (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.27–0.53; P < 0.001) and overall survival (HR, 0.30; 95% CI, 0.17–0.55; P < 0.001). In those aged 70–75 years, quadruplet therapy was independently associated with superior PFS (HR, 0.29; 95% CI, 0.12–0.73; P = 0.009). Similarly, in non-transplant recipients, quadruplet therapy remained a favorable predictor of PFS (HR, 0.40; 95% CI, 0.19–0.87; P = 0.021).

Conclusion

Intensive treatment strategies—including ASCT and quadruplet therapy—are both feasible and beneficial for selected patients with MM aged ≥ 65 years. Therefore, chronological age alone should not be used to determine treatment eligibility. These findings provide real-world evidence that supports a shift toward individualized fitness-based treatment approaches to optimize outcomes in older patients with MM.