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Multiple myeloma in elderly patients—a Portuguese multicentric real-life study

  • Cristina JoãoEmail author
  • Rui Bergantim
  • Manuel Neves
  • Sérgio Chacim
  • Celina Afonso
  • João Barradas
  • Manuela Bernardo
  • Henrique Coelho
  • Graça Esteves
  • Cristina Fraga
  • Catarina Geraldes
  • Cristina Gonçalves
  • Ana Jorge
  • Ana Macedo
  • Teresa Mendonça
  • Andreia Moreira
  • Adriana Roque
  • Ana Bela Sarmento
  • Fernanda Trigo
  • Helena Vitória
  • Susana Esteves
  • Paulo Lúcio
Original Article
  • 79 Downloads

Abstract

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.

Keywords

Multiple myeloma Real-life study Elderly patients Comorbidities 

Notes

Author Contribution

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Cristina João
    • 1
    Email author
  • Rui Bergantim
    • 2
  • Manuel Neves
    • 1
  • Sérgio Chacim
    • 3
  • Celina Afonso
    • 4
  • João Barradas
    • 5
  • Manuela Bernardo
    • 6
  • Henrique Coelho
    • 7
  • Graça Esteves
    • 8
  • Cristina Fraga
    • 9
  • Catarina Geraldes
    • 10
  • Cristina Gonçalves
    • 11
  • Ana Jorge
    • 4
  • Ana Macedo
    • 12
  • Teresa Mendonça
    • 6
  • Andreia Moreira
    • 9
  • Adriana Roque
    • 10
  • Ana Bela Sarmento
    • 10
  • Fernanda Trigo
    • 2
  • Helena Vitória
    • 5
  • Susana Esteves
    • 13
  • Paulo Lúcio
    • 1
  1. 1.Hematology Department, Hemato-oncology UnitClinical Center of the Champalimaud Center for the UnknownLisbonPortugal
  2. 2.Hematology DepartmentCentro Hospitalar S. JoãoPortoPortugal
  3. 3.Hematology DepartmentInstituto Português de Oncologia do PortoPortoPortugal
  4. 4.Hematology DepartmentCentro Hospitalar de Lisboa OcidentalLisbonPortugal
  5. 5.Hematology DepartmentHospital de S. TeotónioViseuPortugal
  6. 6.Hematology DepartmentInstituto Português de Oncologia de LisboaLisbonPortugal
  7. 7.Hematology DepartmentCentro Hospitalar Gaia/EspinhoVila Nova de GaiaPortugal
  8. 8.Hematology DepartmentCentro Hospitalar de Lisboa NorteLisbonPortugal
  9. 9.Hematology DepartmentHospital do Divino Espirito SantoPonta DelgadaPortugal
  10. 10.Hematology DepartmentCentro Hospitalar e Universitário de CoimbraCoimbraPortugal
  11. 11.Hematology DepartmentCentro Hospitalar do PortoPortoPortugal
  12. 12.Hematology DepartmentCentro Hospitalar do AlgarvePortimãoPortugal
  13. 13.Clinical Research UnitInstituto Português de Oncologia de LisboaLisbonPortugal

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