Contributions
Abstract: PB1971
Type: Publication Only
Background
Many new agents for multiple myeloma (MM) were launched during the last decade, and the clinical trial using such new agents showed promising results for MM patients. However, clinical course of elderly patients with newly diagnosed MM (NDMM) in the real world is different from the results of clinical trial.
Aims
We examined the clinical parameter to assess survival in elderly patients with NDMM in clinical practice.
Methods
We performed a retrospective study involving 125 elderly NDMM patients from April 2012 to September 2015. Patients aged 60 years or older, who were ineligible for autologous stem cell transplantation, were selected. The study included 57 males and 68 females, with median age at diagnosis of 74 years (range, 60-95 years). ECOG performance status at diagnosis were 0-1, 67; 2-4, 58. We collected pretreatment parameter at diagnosis as follows; monoclonal protein type (IgG,60; IgA,32; IgD,1; BJP,30; non-secretary,2), light chain (kappa, 72; lambda, 52; unknown 1), hemoglobin level (mean 8.9 g/dL [range 5.8-15.2]), estimated glomerular filtration rate (eGFR) (mean 49.3 mL/min [range 3.6-114.2]), calcium level (mean 10.0 mg/dL [range 8.7-20.2]), albumin level (mean 3.4 g/dL [range 1.0-5.3]), beta-2-microglobulin (mean 5.1 mg/L [range 1.6-51.5]), involved:uninvolved serum free-light chain (FLC) ratio (mean 143.8 [1.83-21133]), cytogenetic abnormalities by using fluorescence in situ hybridization (FISH) [none, 53; t(4;14), 7; del(17p), 14; t(4;14) & del(17p), 5; t(4;14) & t(14;16) & del(17p), 1].
Results
Of 125 patients, 76 patients received bortezomib based therapy (VMP, 49; VD, 21; VCD, 6), 6 patients received lenalidomide based therapy (Ld, 6), 10 patients were received MP therapy, 19 patients received dexamethasone therapy (high dose, 16; low dose, 3), 1 patient received radiation therapy as first line therapy, and 13 patients received only supportive care due to their fragility. After induction therapy, the overall response rate (at least partial response, PR) was 52.7% (stringent complete response (sCR) 0.3%, CR 4.5%, very good PR 16.1%, PR 29.5%). Overall survival (OS) was 74.5% at 1 year, 66.2% at 2 years with median follow-up of 19 months (range 1-52) for patients who were still alive at the date of last contact and 14 months (range 1-52) for entire cohort. Death occurred in 41 patients during the follow-up period. International staging system (ISS), with ISS1, 19; ISS2, 42; ISS3, 60; N/A, 4, can divide elderly patients into three distinct survival groups (P <0.001) (Figure 1). Univariate and multivariate analysis showed a lower OS was associated with eGFR lower than 40 ml/min (HR 2.279, 95%CI 1.152-4.510) (Figure 2) and serum calcium level greater than 11 mg/dL (HR 3.036, 95%CI 1.412-6.529) (Figure 3). Among 80 patients with FISH data, survival of those with t(4;14) or del(17p) or t(14;16) was not statistically different (P = 0.394). Survival of patients treated with bortezomib or lenalidomide as an induction therapy was better, while not statistically significant (P = 0.066) than those who ware not.
Conclusion
Renal dysfunction and hypercalcemia at diagnosis is predictive of poor OS for elderly NDMM patients in real world.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Renal impairment, Prognostic factor, Myeloma, Elderly
Abstract: PB1971
Type: Publication Only
Background
Many new agents for multiple myeloma (MM) were launched during the last decade, and the clinical trial using such new agents showed promising results for MM patients. However, clinical course of elderly patients with newly diagnosed MM (NDMM) in the real world is different from the results of clinical trial.
Aims
We examined the clinical parameter to assess survival in elderly patients with NDMM in clinical practice.
Methods
We performed a retrospective study involving 125 elderly NDMM patients from April 2012 to September 2015. Patients aged 60 years or older, who were ineligible for autologous stem cell transplantation, were selected. The study included 57 males and 68 females, with median age at diagnosis of 74 years (range, 60-95 years). ECOG performance status at diagnosis were 0-1, 67; 2-4, 58. We collected pretreatment parameter at diagnosis as follows; monoclonal protein type (IgG,60; IgA,32; IgD,1; BJP,30; non-secretary,2), light chain (kappa, 72; lambda, 52; unknown 1), hemoglobin level (mean 8.9 g/dL [range 5.8-15.2]), estimated glomerular filtration rate (eGFR) (mean 49.3 mL/min [range 3.6-114.2]), calcium level (mean 10.0 mg/dL [range 8.7-20.2]), albumin level (mean 3.4 g/dL [range 1.0-5.3]), beta-2-microglobulin (mean 5.1 mg/L [range 1.6-51.5]), involved:uninvolved serum free-light chain (FLC) ratio (mean 143.8 [1.83-21133]), cytogenetic abnormalities by using fluorescence in situ hybridization (FISH) [none, 53; t(4;14), 7; del(17p), 14; t(4;14) & del(17p), 5; t(4;14) & t(14;16) & del(17p), 1].
Results
Of 125 patients, 76 patients received bortezomib based therapy (VMP, 49; VD, 21; VCD, 6), 6 patients received lenalidomide based therapy (Ld, 6), 10 patients were received MP therapy, 19 patients received dexamethasone therapy (high dose, 16; low dose, 3), 1 patient received radiation therapy as first line therapy, and 13 patients received only supportive care due to their fragility. After induction therapy, the overall response rate (at least partial response, PR) was 52.7% (stringent complete response (sCR) 0.3%, CR 4.5%, very good PR 16.1%, PR 29.5%). Overall survival (OS) was 74.5% at 1 year, 66.2% at 2 years with median follow-up of 19 months (range 1-52) for patients who were still alive at the date of last contact and 14 months (range 1-52) for entire cohort. Death occurred in 41 patients during the follow-up period. International staging system (ISS), with ISS1, 19; ISS2, 42; ISS3, 60; N/A, 4, can divide elderly patients into three distinct survival groups (P <0.001) (Figure 1). Univariate and multivariate analysis showed a lower OS was associated with eGFR lower than 40 ml/min (HR 2.279, 95%CI 1.152-4.510) (Figure 2) and serum calcium level greater than 11 mg/dL (HR 3.036, 95%CI 1.412-6.529) (Figure 3). Among 80 patients with FISH data, survival of those with t(4;14) or del(17p) or t(14;16) was not statistically different (P = 0.394). Survival of patients treated with bortezomib or lenalidomide as an induction therapy was better, while not statistically significant (P = 0.066) than those who ware not.
Conclusion
Renal dysfunction and hypercalcemia at diagnosis is predictive of poor OS for elderly NDMM patients in real world.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Renal impairment, Prognostic factor, Myeloma, Elderly