{"id":10227,"date":"2026-10-07T14:46:04","date_gmt":"2026-10-07T13:46:04","guid":{"rendered":"https:\/\/www.library.sath.nhs.uk\/research\/?p=10227"},"modified":"2026-10-07T14:46:05","modified_gmt":"2026-10-07T13:46:05","slug":"melphalan-dosing-in-autologous-stem-cell-transplant-should-we-still-dose-adjust-for-older-patients-2026","status":"publish","type":"post","link":"https:\/\/www.library.sath.nhs.uk\/research\/2026\/10\/07\/melphalan-dosing-in-autologous-stem-cell-transplant-should-we-still-dose-adjust-for-older-patients-2026\/","title":{"rendered":"Melphalan dosing in autologous stem cell transplant. Should we still dose adjust for older patients? (2026)"},"content":{"rendered":"\n

Type of publication:<\/strong><\/p>\n\n\n\n

Conference abstract<\/p>\n\n\n\n

Author(s):<\/strong><\/p>\n\n\n\n

Lloyd R.; McIlroy G.; Odusanmi S.; Litt E.; Swart-Rimmer I.; Shafeek S.; Jouni H.; Ahmad H.; Smith L.; Wandroo F.; Ferguson P.<\/p>\n\n\n\n

Citation:<\/strong><\/p>\n\n\n\n

British Journal of Haematology. Conference: 66th Annual Scientific Meeting of the British Society for Haematology. Liverpool United Kingdom. 208(Supplement 1) (pp S48), 2026. Date of Publication: 01 Apr 2026.<\/p>\n\n\n\n

Abstract:<\/strong><\/p>\n\n\n\n

Background: High dose melphalan with autologous stem cell transplant (ASCT) has formed the basis of consolidation therapy in newly diagnosed multiple myeloma for around 2 decades. In the UK, patients deemed fit for transplant are prescribed either 200 mg\/m2 (HImel) or 140 mg\/m2 (INTmel) of melphalan based on renal function or age. As populations remain fit into older age, more patients >=65 have been treated with 200 mg\/m2 melphalan. There is a lack of evidence base in this population. Analysis aims to determine if there is any difference in efficacy and toxicity in treating patients >=65 with high dose melphalan in a ASCT.
Method(s): Patients with multiple myeloma treated with single agent melphalan ASCT between 2013 and 2023 were included in data collection. Patients undergoing second or tandem autologous transplants were excluded. Dosage of melphalan was decided by the clinician at the time of review. Primary endpoints were PFS and OS, secondary endpoints were toxicity and length of hospital stay.
Result(s): 679 patients were eligible with an average age of 61.14 years. A total of 446 patients received HImel with 85 of these >=65. 232 patients received INTmel with 189 of these >=65. 20 patients were admitted to ITU (2.9%), 4 patients were >=65 with 2 receiving HImel and 2 receiving INTmel. 6 patients (0.88%) died from transplant related complications. 3 of these patients were <65 and received HImel. 3 patients were >=65 and 1 received HImel. There was a significant difference in the length of admission for the <65 HImel group compared to the >=65 HImel group (18.1 vs 21.2days, p value=000286). This difference was not replicated in the INTmel group 21.3 vs 21days. (p-value 0.404328). Overall, there was a statistically significant shorter length of stay for the <65 cohort compared with the >=65 cohort (p value 0.00057). There was no statistically significant difference in overall survival between the groups (<64 HImel 88 months, <65 INTmel 74.3 months, >=65 HImel 74.71 months, >=65 INTmel 73.7 months). There was no significant difference in PFS between the groups (<65 HImel 53.8 months, <65 INTmel 50.4, >=65 HImel 57.46, >=65 42.09 months).
Conclusion(s): The study demonstrates that there is no OS or PFS advantage with treating older patients with high dose melphalan. There were longer hospital stays associated with increasing age. Patients who present older, but still fit for transplant have little evidence on the best way to proceed with treatment.<\/p>\n\n\n\n

DOI<\/strong>: 10.1111\/bjh.70471<\/p>\n\n\n\n

Link to full-text<\/a> [no password required]<\/p>\n","protected":false},"excerpt":{"rendered":"

Type of publication: Conference abstract Author(s): Lloyd R.; McIlroy G.; Odusanmi S.; Litt E.; Swart-Rimmer I.; Shafeek S.; Jouni H.; Ahmad H.; Smith L.; Wandroo F.; Ferguson P. Citation: British Journal of Haematology. Conference: 66th Annual Scientific Meeting of the…<\/span><\/p>\n

Read more Melphalan dosing in autologous stem cell transplant. Should we still dose adjust for older patients? (2026)<\/span> ›<\/span><\/a><\/div>\n

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