Contributions
Abstract: PB1992
Type: Publication Only
Background
Multiple Myeloma (MM) is mainly a disease of the elderly and the very elderly patients (80 years of age or more) comprise one third about of all MM patients. This subset of patients suffer from concomitant disabilities and/or comorbidities and require a different and a more individualized therapeutic approach, including the novel agents.
Aims
The aim of our study is to verify safety and efficacy of novel agents with the reliability to maintain a good quality of life and obtain a maximal disease control.
Methods
Patients from 8 Hematology Centers of the “Rete Ematologica Pugliese (REP)” were included in this study. Between January 2011 and December 2016, 71 patients (M/F: 42/29) with a median age of 82 years (range 80-91) were diagnosed as newly symptomatic MM. Of the entire study population, 40 (56%) patients showed an ECOG score lower than 2. According to immunoglobulin heavy and light chain isotypes, patients had IgG-k (n=23), IgG-λ (n=16), IgA-k (n=14), IgA-λ (n=6), micromolecular k (n=8) and λ (n=4) chains. On the basis of ISS, patients were classified as I (n=4) score, II (n=23) and III (n=44) score, respectively. When CRAB features were considered, bone lesions represented the most frequent (n=43, 60.6%) clinical manifestations, while anemia, hypercalcemia and renal failure were found in 35 (49.3%), 2 (2.8%) and 2 (2.8%) patients, respectively. Majority of patients (n=49, 69%) showed at least 1 comorbidity requiring specific treatments, and 11 patients (15,5%) showed more than 3 comorbidities. Patients were treated according to Bortezomib-based regimens (VMP, VCD and VD) (n=45; 63.4%), Lenalidomide-based regimen (RD) (n=8; 11,3%) and Thalidomide-based regimen (MPT) (n=5; 7%). Only 13 patients (18.3%) did not receive any novel agent.
Results
Based on IMWG criteria, 15 patients (21.1%) achieved a CR, 15 patients (21.1%) a VGPR and 15 patients (21.1%) a PR. Fourteen patients (19.7%) and 12 (17%) patients experienced a SD and a PD, respectively. As second line of treatment, Bortezomib was used in 14 (33.3%) patients, Lenalidomide in 17 (40.5%) patients and Thalidomide in 3 (7,2%) patients. Height patients (19%) were treated with old drugs (Melphalan, Cyclophosphamide or Bendamustine). Pomalidomide was used as third line-therapy in 3 patients. After 72 months (median 32.5 months) of follow-up, 33 (46.5%) patients remained alive with a median survival of 36 months and 25 (28.2%) died. Last follow-up from 13 patients was unavailable. Hematological and extra-hematological toxicities were similarly distributed (18,3% and 18,3%, respectively) and usually weak/moderate. Neuropathy was the most common toxicity reported (n=5, 7%). Of patients treated with only novel agents (n=58), hematological and extra-hematological toxicity was observed in 14% and 16% patients, respectively.
Conclusion
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Abstract: PB1992
Type: Publication Only
Background
Multiple Myeloma (MM) is mainly a disease of the elderly and the very elderly patients (80 years of age or more) comprise one third about of all MM patients. This subset of patients suffer from concomitant disabilities and/or comorbidities and require a different and a more individualized therapeutic approach, including the novel agents.
Aims
The aim of our study is to verify safety and efficacy of novel agents with the reliability to maintain a good quality of life and obtain a maximal disease control.
Methods
Patients from 8 Hematology Centers of the “Rete Ematologica Pugliese (REP)” were included in this study. Between January 2011 and December 2016, 71 patients (M/F: 42/29) with a median age of 82 years (range 80-91) were diagnosed as newly symptomatic MM. Of the entire study population, 40 (56%) patients showed an ECOG score lower than 2. According to immunoglobulin heavy and light chain isotypes, patients had IgG-k (n=23), IgG-λ (n=16), IgA-k (n=14), IgA-λ (n=6), micromolecular k (n=8) and λ (n=4) chains. On the basis of ISS, patients were classified as I (n=4) score, II (n=23) and III (n=44) score, respectively. When CRAB features were considered, bone lesions represented the most frequent (n=43, 60.6%) clinical manifestations, while anemia, hypercalcemia and renal failure were found in 35 (49.3%), 2 (2.8%) and 2 (2.8%) patients, respectively. Majority of patients (n=49, 69%) showed at least 1 comorbidity requiring specific treatments, and 11 patients (15,5%) showed more than 3 comorbidities. Patients were treated according to Bortezomib-based regimens (VMP, VCD and VD) (n=45; 63.4%), Lenalidomide-based regimen (RD) (n=8; 11,3%) and Thalidomide-based regimen (MPT) (n=5; 7%). Only 13 patients (18.3%) did not receive any novel agent.
Results
Based on IMWG criteria, 15 patients (21.1%) achieved a CR, 15 patients (21.1%) a VGPR and 15 patients (21.1%) a PR. Fourteen patients (19.7%) and 12 (17%) patients experienced a SD and a PD, respectively. As second line of treatment, Bortezomib was used in 14 (33.3%) patients, Lenalidomide in 17 (40.5%) patients and Thalidomide in 3 (7,2%) patients. Height patients (19%) were treated with old drugs (Melphalan, Cyclophosphamide or Bendamustine). Pomalidomide was used as third line-therapy in 3 patients. After 72 months (median 32.5 months) of follow-up, 33 (46.5%) patients remained alive with a median survival of 36 months and 25 (28.2%) died. Last follow-up from 13 patients was unavailable. Hematological and extra-hematological toxicities were similarly distributed (18,3% and 18,3%, respectively) and usually weak/moderate. Neuropathy was the most common toxicity reported (n=5, 7%). Of patients treated with only novel agents (n=58), hematological and extra-hematological toxicity was observed in 14% and 16% patients, respectively.
Conclusion
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical