CHEMOTHERAPY ADHERENCE IS FAVORABLE PROGNOSTIC FACTOR FOR ELDERLY PATIENTS WITH MULTIPLE MYELOMA WHO TREATED WITH FRONTLINE BORTEZOMIB CONTAINING REGIMEN
(Abstract release date: 05/19/16)
EHA Library. MOON J. 06/09/16; 134879; PB1979
Prof. Joon Ho MOON
Contributions
Contributions
Abstract
Abstract: PB1979
Type: Publication Only
Background
Elderly patients with multiple myeloma (MM) are vulnerable to adverse events and the patients’ treatment goal may be different from young patients. For elderly patients with MM, the toxicity of bortezomib (BTZ)-based regimen causes frequent dose reduction and interruption of BTZ which could result in poor outcomes.
Aims
This study evaluated the adherence to chemotherapy and treatment outcomes for elderly patients who treated with frontline BTZ containing regimen and non-BTZ containing regimens.
Methods
This study retrospectively analyzed the outcomes of 146 elderly patients (≥65 years) with MM diagnosed from 2007 Mar to 2015 Mar. To evaluate the regimen adherence, the patients who treated with more than 4 cycles were regarded as favorable adherence group and the others as unfavorable adherence group. The effects of toxicity on the adherence to frontline regimen and long term outcomes were also evaluated in the current study.
Results
Among 146 patients, frontline therapy was VMP in 77 patients (52.7%), MP in 50 (34.2%) and CTD in 19 (13.0%). Median age at diagnosis was 70 years (range 65-90 years) and 85 patients (58.2%) were over 70 years old. ECOG performance status showed 2-4 in 49 patients (33.6%). ISS risk groups were stage I in 14 patients (9.6%), II in 64 (43.8%), and III in 68 (46.6%). Median cycles of frontline regimens were 5 cycles (range 1-9 cycles) with VMP and 6 cycles (range 1-77 cycles) with non-BTZ containing regimens (p=0.032). Maximal treatment response was ≥VGPR in 40 patients (51.9%) and 13 (18.8%) in VMP regimen and non-BTZ regimens, respectively (p<0.001). Regimen adherence was favorable in 49 patients (63.6%) and 52 (75.4%) in frontline VMP regimen and non-BTZ regimens, respectively (p=0.126). Major cause of non-adherence was side effects in VMP, while poor response and regimen change were major causes of non-adherence in non-BTZ regimens. Despite poor response to frontline chemotherapy in non-BTZ regimens, 3-year overall survival (OS) rate was not significantly different compared to frontline VMP regimen: 65.3±8.2% and 47.9±7.8% in VMP and non-BTZ regimens (p=0.159) because all the patients who showed poor response to frontline therapy received second-line BTZ containing regimens. However, among the patients with frontline VMP regimen, those with good adherence to chemotherapy resulted in better 3-year OS rate than those with poor adherence: 72.4±9.7% and 52.6±13.2% (p=0.002). In the multivariate analysis, ECOG performance status 2-4 (HR 3.409, 95% CI 1.133-10.261, p=0.029) and non-adherence to chemotherapy (HR 4.896, 95% CI 1.617-14.829, p=0.005) were poor prognostic factors for OS.
Conclusion
Frontline BTZ-containing regimen showed higher response rate than non-BTZ regimens and good adherence was associated with favorable long-term outcomes. However, regimen adherence was compromized for high incidence of adverse effects with BTZ-contaiing regimen. Therefore, understanding the risk of toxicities and adequate management of side effects needed to have favorable outcomes for the patients with BTZ containing regimen.
Session topic: E-poster
Keyword(s): Bortezomib, Elderly, Myeloma, Side effects
Type: Publication Only
Background
Elderly patients with multiple myeloma (MM) are vulnerable to adverse events and the patients’ treatment goal may be different from young patients. For elderly patients with MM, the toxicity of bortezomib (BTZ)-based regimen causes frequent dose reduction and interruption of BTZ which could result in poor outcomes.
Aims
This study evaluated the adherence to chemotherapy and treatment outcomes for elderly patients who treated with frontline BTZ containing regimen and non-BTZ containing regimens.
Methods
This study retrospectively analyzed the outcomes of 146 elderly patients (≥65 years) with MM diagnosed from 2007 Mar to 2015 Mar. To evaluate the regimen adherence, the patients who treated with more than 4 cycles were regarded as favorable adherence group and the others as unfavorable adherence group. The effects of toxicity on the adherence to frontline regimen and long term outcomes were also evaluated in the current study.
Results
Among 146 patients, frontline therapy was VMP in 77 patients (52.7%), MP in 50 (34.2%) and CTD in 19 (13.0%). Median age at diagnosis was 70 years (range 65-90 years) and 85 patients (58.2%) were over 70 years old. ECOG performance status showed 2-4 in 49 patients (33.6%). ISS risk groups were stage I in 14 patients (9.6%), II in 64 (43.8%), and III in 68 (46.6%). Median cycles of frontline regimens were 5 cycles (range 1-9 cycles) with VMP and 6 cycles (range 1-77 cycles) with non-BTZ containing regimens (p=0.032). Maximal treatment response was ≥VGPR in 40 patients (51.9%) and 13 (18.8%) in VMP regimen and non-BTZ regimens, respectively (p<0.001). Regimen adherence was favorable in 49 patients (63.6%) and 52 (75.4%) in frontline VMP regimen and non-BTZ regimens, respectively (p=0.126). Major cause of non-adherence was side effects in VMP, while poor response and regimen change were major causes of non-adherence in non-BTZ regimens. Despite poor response to frontline chemotherapy in non-BTZ regimens, 3-year overall survival (OS) rate was not significantly different compared to frontline VMP regimen: 65.3±8.2% and 47.9±7.8% in VMP and non-BTZ regimens (p=0.159) because all the patients who showed poor response to frontline therapy received second-line BTZ containing regimens. However, among the patients with frontline VMP regimen, those with good adherence to chemotherapy resulted in better 3-year OS rate than those with poor adherence: 72.4±9.7% and 52.6±13.2% (p=0.002). In the multivariate analysis, ECOG performance status 2-4 (HR 3.409, 95% CI 1.133-10.261, p=0.029) and non-adherence to chemotherapy (HR 4.896, 95% CI 1.617-14.829, p=0.005) were poor prognostic factors for OS.
Conclusion
Frontline BTZ-containing regimen showed higher response rate than non-BTZ regimens and good adherence was associated with favorable long-term outcomes. However, regimen adherence was compromized for high incidence of adverse effects with BTZ-contaiing regimen. Therefore, understanding the risk of toxicities and adequate management of side effects needed to have favorable outcomes for the patients with BTZ containing regimen.
Session topic: E-poster
Keyword(s): Bortezomib, Elderly, Myeloma, Side effects
Abstract: PB1979
Type: Publication Only
Background
Elderly patients with multiple myeloma (MM) are vulnerable to adverse events and the patients’ treatment goal may be different from young patients. For elderly patients with MM, the toxicity of bortezomib (BTZ)-based regimen causes frequent dose reduction and interruption of BTZ which could result in poor outcomes.
Aims
This study evaluated the adherence to chemotherapy and treatment outcomes for elderly patients who treated with frontline BTZ containing regimen and non-BTZ containing regimens.
Methods
This study retrospectively analyzed the outcomes of 146 elderly patients (≥65 years) with MM diagnosed from 2007 Mar to 2015 Mar. To evaluate the regimen adherence, the patients who treated with more than 4 cycles were regarded as favorable adherence group and the others as unfavorable adherence group. The effects of toxicity on the adherence to frontline regimen and long term outcomes were also evaluated in the current study.
Results
Among 146 patients, frontline therapy was VMP in 77 patients (52.7%), MP in 50 (34.2%) and CTD in 19 (13.0%). Median age at diagnosis was 70 years (range 65-90 years) and 85 patients (58.2%) were over 70 years old. ECOG performance status showed 2-4 in 49 patients (33.6%). ISS risk groups were stage I in 14 patients (9.6%), II in 64 (43.8%), and III in 68 (46.6%). Median cycles of frontline regimens were 5 cycles (range 1-9 cycles) with VMP and 6 cycles (range 1-77 cycles) with non-BTZ containing regimens (p=0.032). Maximal treatment response was ≥VGPR in 40 patients (51.9%) and 13 (18.8%) in VMP regimen and non-BTZ regimens, respectively (p<0.001). Regimen adherence was favorable in 49 patients (63.6%) and 52 (75.4%) in frontline VMP regimen and non-BTZ regimens, respectively (p=0.126). Major cause of non-adherence was side effects in VMP, while poor response and regimen change were major causes of non-adherence in non-BTZ regimens. Despite poor response to frontline chemotherapy in non-BTZ regimens, 3-year overall survival (OS) rate was not significantly different compared to frontline VMP regimen: 65.3±8.2% and 47.9±7.8% in VMP and non-BTZ regimens (p=0.159) because all the patients who showed poor response to frontline therapy received second-line BTZ containing regimens. However, among the patients with frontline VMP regimen, those with good adherence to chemotherapy resulted in better 3-year OS rate than those with poor adherence: 72.4±9.7% and 52.6±13.2% (p=0.002). In the multivariate analysis, ECOG performance status 2-4 (HR 3.409, 95% CI 1.133-10.261, p=0.029) and non-adherence to chemotherapy (HR 4.896, 95% CI 1.617-14.829, p=0.005) were poor prognostic factors for OS.
Conclusion
Frontline BTZ-containing regimen showed higher response rate than non-BTZ regimens and good adherence was associated with favorable long-term outcomes. However, regimen adherence was compromized for high incidence of adverse effects with BTZ-contaiing regimen. Therefore, understanding the risk of toxicities and adequate management of side effects needed to have favorable outcomes for the patients with BTZ containing regimen.
Session topic: E-poster
Keyword(s): Bortezomib, Elderly, Myeloma, Side effects
Type: Publication Only
Background
Elderly patients with multiple myeloma (MM) are vulnerable to adverse events and the patients’ treatment goal may be different from young patients. For elderly patients with MM, the toxicity of bortezomib (BTZ)-based regimen causes frequent dose reduction and interruption of BTZ which could result in poor outcomes.
Aims
This study evaluated the adherence to chemotherapy and treatment outcomes for elderly patients who treated with frontline BTZ containing regimen and non-BTZ containing regimens.
Methods
This study retrospectively analyzed the outcomes of 146 elderly patients (≥65 years) with MM diagnosed from 2007 Mar to 2015 Mar. To evaluate the regimen adherence, the patients who treated with more than 4 cycles were regarded as favorable adherence group and the others as unfavorable adherence group. The effects of toxicity on the adherence to frontline regimen and long term outcomes were also evaluated in the current study.
Results
Among 146 patients, frontline therapy was VMP in 77 patients (52.7%), MP in 50 (34.2%) and CTD in 19 (13.0%). Median age at diagnosis was 70 years (range 65-90 years) and 85 patients (58.2%) were over 70 years old. ECOG performance status showed 2-4 in 49 patients (33.6%). ISS risk groups were stage I in 14 patients (9.6%), II in 64 (43.8%), and III in 68 (46.6%). Median cycles of frontline regimens were 5 cycles (range 1-9 cycles) with VMP and 6 cycles (range 1-77 cycles) with non-BTZ containing regimens (p=0.032). Maximal treatment response was ≥VGPR in 40 patients (51.9%) and 13 (18.8%) in VMP regimen and non-BTZ regimens, respectively (p<0.001). Regimen adherence was favorable in 49 patients (63.6%) and 52 (75.4%) in frontline VMP regimen and non-BTZ regimens, respectively (p=0.126). Major cause of non-adherence was side effects in VMP, while poor response and regimen change were major causes of non-adherence in non-BTZ regimens. Despite poor response to frontline chemotherapy in non-BTZ regimens, 3-year overall survival (OS) rate was not significantly different compared to frontline VMP regimen: 65.3±8.2% and 47.9±7.8% in VMP and non-BTZ regimens (p=0.159) because all the patients who showed poor response to frontline therapy received second-line BTZ containing regimens. However, among the patients with frontline VMP regimen, those with good adherence to chemotherapy resulted in better 3-year OS rate than those with poor adherence: 72.4±9.7% and 52.6±13.2% (p=0.002). In the multivariate analysis, ECOG performance status 2-4 (HR 3.409, 95% CI 1.133-10.261, p=0.029) and non-adherence to chemotherapy (HR 4.896, 95% CI 1.617-14.829, p=0.005) were poor prognostic factors for OS.
Conclusion
Frontline BTZ-containing regimen showed higher response rate than non-BTZ regimens and good adherence was associated with favorable long-term outcomes. However, regimen adherence was compromized for high incidence of adverse effects with BTZ-contaiing regimen. Therefore, understanding the risk of toxicities and adequate management of side effects needed to have favorable outcomes for the patients with BTZ containing regimen.
Session topic: E-poster
Keyword(s): Bortezomib, Elderly, Myeloma, Side effects
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