Treatment options and outcomes for multiple myeloma (MM) pts were greatly changed over the last 10 years. Treatment according to different age groups requires careful consideration of the balance between maximizing efficacy and acceptable tolerability.
100 pts (median age: 63, range 34-80; m: 63, f: 37) were registered in NCI from Jan 2006 to Jan 2018. 19% (19/100) of patients received M2, MP, DAV therapy (group1), 46% (46/100) - thalidomide-based (group2) and 35% (35/100) -PI-based regimens (group3). In 28% patients t(4:14), del13, and del17p13] were assessed. The primary endpoint was EFS and OS.
For 100 pts the ORR was 70 %. We recorded 39% relapses in the follow-up after the 1st line therapy (median – 10.9 months; range 2–129). 61.1% vs 47.8% vs 17.1% relapses were diagnosed in group1 vs group2 vs group3, respectively (p < 0.05). 3-year EFS for group1 was 18% vs 30% in group3 and 20% vs 30% for group2 vs group3, respectively (p = 0.002). ROC analysis confirmed bortezomib-based regimens improved EFS in MM patients without age correlation (Se = 81%; Sp = 54%; AUC=0.7, p = 0.0001). EFS was higher in the group 2 pts <65 y.o. vs > 65 y.o (40% vs 18%, p < 0.05). 3-year OS was 65% vs 45% in younger pts vs elderly pts, respectively (p = 0.009). Thrombosis complications in group 2 were compared in pts >65 y.o (20%) vs < 65 y.o (7.7%), (p < 0.05). 3-year EFS and OS were similar in the group 3 (p = 0.4). Also, neurotoxicity was the same in different age groups (58.6% vs 60%). 50% vs 33.8% cases of disease progression had patients who received doublet and triplet regimens, respectively (p < 0.05). ROC analysis confirmed doublet regimen association with lower EFS pts >65 y.o (Se = 50%; Sp = 100%; AUC=0.7, p = 0.04). Median EFS in pts with del17p13 was lower without any correlation with age (10.9 vs 29.7 months). We did not find any significant association between patients with del13 or t(4:14) and clinical outcome of MM.
Bortezomib-based regimens are still in a priority for the 1st-line treatment in different age groups. Thalidomide might be an option for younger pts, because thrombosis events are more frequent in elderly pts. To achieve better response in the 1st-line therapy, it is preferable to use triplet regimens in pts <65 and >65 years old.
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