Multiple myeloma (MM) affects elderly individuals with two-thirds of patients aged >65 years at diagnosis, 35% ≥75 and 10% ≥80. In general, routine clinical practice is based on the results of large, multicenter, randomized clinical trials. However, despite efforts from cooperative groups, patients enrolled in trials are generally younger and presumably healthier than the typical older patient with MM
To describe prescription patterns for first-line treatment of non-transplant eligible MM patients in the setting of real-life practice and to analyze treatment outcome according to patients’ age
Retrospective analysis of newly diagnosed MM patients not eligible for transplantation, who started anti-myeloma treatment between 2012-2016 in 20 Spanish hospitals. Variables collected included patients’ characteristics at diagnosis (ECOG, laboratory parameters, ISS, and cytogenetics/fluorescent in situ hybridization), characteristics of first-line treatment, overall survival (OS), progression-free survival (PFS), and overall response rate (ORR), defined as partial response or better
The retrospective cohort included 421 patients with a median age of 76 years (41-90); 203 (49%), 106 (26%), and 104 (25%) were ≤75, 76-80, and >80 years old, respectively; 28 (12%) had ECOG >2. ISS staging was I, II, III in 57 (18%), 93 (30%), and 160 (52%) patients, respectively; 73 (25%) patients had high-risk cytogenetics. The most frequently prescribed regimen was VMP (208 patients), followed by other bortezomib-based regimens (130 patients) (Table 1). Overall, median treatment duration was 6 months (95%CI 5-7) and the ORR was 74% (for patients ≤75, 75-80, and >80 years old: 76%, 80%, and 62%; P = 0.025). Overall, 188 (45%) patients required a dose adjustment and 225 (81%) started second-line treatment. Median OS and PFS were 32 (95% CI 29-37) and 15 months (95% CI 14-17), respectively. OS and PFS of patients ≤75, 75-80, and >80 years old were 44 and 16 months, 28 and 17 months, and 23 and 12 months (P < 0.01 for age-group differences in both OS and PFS).
In real-life practice, there is high variability in treatment regimens, being bortezomib-based the most frequently prescribed regimens in the study period. Besides the clinical characteristics of MM patients, age influenced survival in our cohort of real-life patients, suggesting that treatment choice for elderly patients should be based on a specific pre-treatment assessment of risks and benefits.