Multiple myeloma in elderly patients—a Portuguese multicentric real-life study
Patients older than 75 years old with multiple myeloma (MM) have shorter survival and are usually treated differently from what features in clinical trials. In this study, the authors characterized the Portuguese population of MM patients above 75 years old, treated between 2009 and 2016. We compared the outcomes obtained with bortezomib-based protocols (BBP), thalidomide-based protocols (TBP), and chemotherapy (CT) using univariate and multivariate controlling for age, performance status, International Staging System score, renal impairment, and number of comorbidities. We retrieved data from 386 patients, treated in 12 hospitals. Three hundred thirty-one cases were analyzed: 119 patients treated with BBP, 65 with TBP, 147 with CT. Median age was 79 years; CT-treated patients were older, had a worse performance status, and have more comorbidities. The median follow-up was 25 months. The 2-year OS was 58% and the median OS was 29.5 months. Patients treated with BBP had more frequently very good partial response (VGPR) or better response, and the subgroup of more fit patients had a significantly longer progression-free survival (PFS) and OS. The most frequently grade 3–4 toxicities were hematologic, infectious, and neurologic and were significantly lower in TBP and CT groups vs BBP. The most common second line was CT, followed by lenalidomide. Patients treated with lenalidomide had a higher probability of VGPR or better and a superior 1-year PFS. Despite the limitations of a retrospective study, our cohort represents the reality of older patients with MM in a western country. The hazard of death or progression was higher for old, fit patients treated, in first line, with CT and with TBP compared with that of BBP.
KeywordsMultiple myeloma Real-life study Elderly patients Comorbidities
CJ collected data, designed the analysis, critically reviewed the analysis of the data, and wrote and review the manuscript.
RB, MN, SC, GE, and PL collected data, designed the analysis, and reviewed the manuscript.
SE analyzed the data and reviewed the manuscript.
CA, JB, MB, HC, CF, CG, CG, AJ, AM, TM, AM, AR, AS, FT, and HV collected data and reviewed the manuscript.
Compliance with ethical standards
Conflict of interest
CJ has received a research grant from Takeda and has received speaker honorarium/participation in advisory boards from Celgene, Janssen, Takeda, and Amgen. MN received a speaker honorarium from Janssen, Takeda, Amgen, and Celgene. RB has received a research grant: from APCL/SPH/AMGEN and Celgene and speaker honoraria/advisory board from Celgene, Janssen, Takeda, and Amgen. SC has received speaker honorarium or participation in Advisory Boards from Takeda, Janssen, Celgene, Sanofi, Bristol-Myers Squibb, and Abbvie. CG has received honoraria from Janssen, Celgene, Amgen, and Takeda for lectures and participation in advisory boards. JB declares that he has no conflict of interest. HV has received honoraria from Celgene and Amgen for participation in advisory boards. ABS declares that she has no conflict of interest. TM declares that she has no conflict of interest. AM declares that she has no conflict of interest. AR declares that she has no conflict of interest. SE declares that she has no conflict of interest. AM declares that she has no conflict of interest. FT has received honoraria for speaker services from Takeda, Amgen, Celgene, Janssen, and attendance at advisory boards for Takeda, Amgen, Celgene, and Janssen. HC declares that he has no conflict of interest. CG has received honoraria from Celgene, Amgen, and Janssen for participation in advisory boards. CF has received honoraria for speaker services, attendance at advisory boards, and travel reimbursement from Sanofi Genzyme. MB has received honoraria for speaker services from Janssen and attendance at advisory boards of Celgene, Amgen, Janssen, Takeda, and Merck. GE has received research grants and speaker honorarium from Celgene, Janssen, and Amgen. CA has received honorarium for participation in advisory boards from Amgen, Celgene, Janssen, and Takeda. AJ received a speaker honorarium from Celgene, Janssen, and Novartis. PL has received speaker honorarium/participation in advisory boards from Celgene, Janssen, Takeda, and Amgen.
All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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