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CAN OVERALL SURVIVAL BE IMPROVED IN ELDERLY MULTIPLE MYELOMA PATIENTS?
Author(s): ,
Bart M.S. Heeg
Affiliations:
Ingress-health, Rotterdam,Netherlands
,
Johan Liwing
Affiliations:
Department of Medicine,Karolinska Institutet, Stockholm,Stockholm,Sweden
,
Sigrid Karstorp
Affiliations:
Department of Medicine,Karolinska Institutet, Stockholm,Stockholm,Sweden
,
Maarten Postma
Affiliations:
Unit of PharmacoEpidemiology & PharmacoEconomics,Institute of Science in Healthy Aging & health caRE (SHARE),Groningen,Netherlands
,
Raija Silvennoinen
Affiliations:
Kuopio University Hospital,Kuopio,Finland
,
Mervi Putkonen
Affiliations:
Turku University Hospital,Turku,Finland
,
Pekka Anttila
Affiliations:
HUS,Helsinkki,Finland
,
Kari Remes
Affiliations:
Turku University Hospital,Turku,Finland
,
Niels Abildgaard
Affiliations:
Department of Hematology, Odense University Hospital, Odense,Denmark
,
Anders Waage
Affiliations:
Department of Hematology,St Olavs Hospital,Trondheim,Norway
Hareth Nahi
Affiliations:
Department of Medicine,Karolinska Institutet, Stockholm,Stockholm,Sweden
(Abstract release date: 05/21/15) EHA Library. M.S.Heeg B. 06/12/15; 99979; E1289
Bart M.S.Heeg
Bart M.S.Heeg
Contributions
Abstract
Abstract: E1289

Type: Eposter Presentation

Background
The ongoing introduction of novel therapies for MM provides clinicians and patients various treatment options in numerous lines of treatment. Understanding the current treatment practices and the outcomes in different age groups is of vital importance to understand whether these new treatment should be used in patients from all age groups and where options for treatment optimization exist.

Aims

(i) To describe treatment patterns and corresponding outcomes in terms of response, time to next therapy (TTNT) and overall survival (OS) of Nordic Multiple Myeloma (MM) patients with a focus on age. (ii) To investigate whether age affected the patients’ probability of being treated with a conventional (e.g. melphelan prednisone) or a novel treatment (bortezomib, thalidomide or lenalidomide) and whether this treatment choice affected OS in the elderly.

 

 



Methods

A retrospective analysis was performed on incident 2960 MM-patients from 24 hospitals in Denmark, Finland, Norway and Sweden. The database contained information on patient baseline characteristics such as age, gender, international staging system (ISS) stage, albumin, creatine, MM type and response, TTNT and OS over eight lines of treatment. The patients were stratified over three age groups (<65, 65<75 and ≥75) for which baseline characteristics, treatments, response, TTNT and OS were reported. To validly compare the effectiveness (OS) of novel vs conventional treatments in first line, propensity score matching was used and also multivariate cox-regressions.



Results
Patients were on average 67 years old, 48% were male and 28%, 41% and 31% in ISS stages I, II and III, respectively. The chance of being treated with a conventional therapy increases with age in all lines of therapy. In first line, 13% in younger patients <65 years and 72% of elderly patients ≥75 years were treated with a conventional. Patients seemed to respond better on novel therapies. In first line, patients aged ≥75 years treated with a conventional treatment, novel treatment and stem cell transplantation had a 9%, 28% and 69% probability on a ≥very good partial response respectively. Patients’ ≥75 with no response or progressive disease on first line had a median OS of 1.54 years whereas patients in the same age group with (near) complete response had a median OS of 3.27 years. For patients aged ≥75 years, a matched treatment comparison using propensity scoring showed significantly longer OS for novel therapies 3.61 (2.66-6.44) years versus conventional therapies 2.14 (1.78-2.57) years. Multivariate cox-regression models gave a similar result with an estimated hazard ratio of 0.45 (0.24-0.98).

Summary

This paper shows that in this incident cohort elderly patients are significantly more likely to be treated with a conventional MM therapy than younger patients, while elderly patient do significantly benefit from novel therapies in first line compared to conventional therapies in terms of longer OS. Hence, there is a potential to improve therapy for and further increase the OS among elderly MM patients with novel treatment options.



Keyword(s): Multiple myeloma, Outcome measurement, Survival prediction

Session topic: E-poster
Abstract: E1289

Type: Eposter Presentation

Background
The ongoing introduction of novel therapies for MM provides clinicians and patients various treatment options in numerous lines of treatment. Understanding the current treatment practices and the outcomes in different age groups is of vital importance to understand whether these new treatment should be used in patients from all age groups and where options for treatment optimization exist.

Aims

(i) To describe treatment patterns and corresponding outcomes in terms of response, time to next therapy (TTNT) and overall survival (OS) of Nordic Multiple Myeloma (MM) patients with a focus on age. (ii) To investigate whether age affected the patients’ probability of being treated with a conventional (e.g. melphelan prednisone) or a novel treatment (bortezomib, thalidomide or lenalidomide) and whether this treatment choice affected OS in the elderly.

 

 



Methods

A retrospective analysis was performed on incident 2960 MM-patients from 24 hospitals in Denmark, Finland, Norway and Sweden. The database contained information on patient baseline characteristics such as age, gender, international staging system (ISS) stage, albumin, creatine, MM type and response, TTNT and OS over eight lines of treatment. The patients were stratified over three age groups (<65, 65<75 and ≥75) for which baseline characteristics, treatments, response, TTNT and OS were reported. To validly compare the effectiveness (OS) of novel vs conventional treatments in first line, propensity score matching was used and also multivariate cox-regressions.



Results
Patients were on average 67 years old, 48% were male and 28%, 41% and 31% in ISS stages I, II and III, respectively. The chance of being treated with a conventional therapy increases with age in all lines of therapy. In first line, 13% in younger patients <65 years and 72% of elderly patients ≥75 years were treated with a conventional. Patients seemed to respond better on novel therapies. In first line, patients aged ≥75 years treated with a conventional treatment, novel treatment and stem cell transplantation had a 9%, 28% and 69% probability on a ≥very good partial response respectively. Patients’ ≥75 with no response or progressive disease on first line had a median OS of 1.54 years whereas patients in the same age group with (near) complete response had a median OS of 3.27 years. For patients aged ≥75 years, a matched treatment comparison using propensity scoring showed significantly longer OS for novel therapies 3.61 (2.66-6.44) years versus conventional therapies 2.14 (1.78-2.57) years. Multivariate cox-regression models gave a similar result with an estimated hazard ratio of 0.45 (0.24-0.98).

Summary

This paper shows that in this incident cohort elderly patients are significantly more likely to be treated with a conventional MM therapy than younger patients, while elderly patient do significantly benefit from novel therapies in first line compared to conventional therapies in terms of longer OS. Hence, there is a potential to improve therapy for and further increase the OS among elderly MM patients with novel treatment options.



Keyword(s): Multiple myeloma, Outcome measurement, Survival prediction

Session topic: E-poster

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