Contributions
Abstract: PB1681
Type: Publication Only
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
First-line treatment with VCD is well-studied in transplantation-eligible younger patients with MM (overall response rate [ORR] 83%, with 56% achieving ≥VGPR). Although VCD has not been approved by the European Medicines Agency for untreated older patients with MM, its use is recognized in the current ESMO guidelines. There have been few systematic studies of VCD in older patients with MM and data on its efficacy and safety is limited.
Aims
We did a retrospective, multicenter, cohort study of newly-diagnosed older patients with MM treated with VCD.
Methods
We identified all newly-diagnosed patients with MM aged ≥70 who were treated with VCD in six Greek hospitals between 2007-2020. We used Kaplan-Meier curves and Cox regression for the primary outcomes (overall survival [OS] and progression-free survival [PFS]).
Results
A total of 99 patients (52 men; 47 women) were included in our study. Median age was 76 years (range, 70-92). 16 patients (16.2%) aged ≥80 years. Performance status (PS) was ≥2 in 44 patients (50%). The median Charlson Comorbidity Index (CCI) was 4 (range, 2‒9); 51.6% had multimorbidity (CCI≥4). 46 patients (54.8%) had ISS 3 and 37 (37.8%) had high LDH. Renal impairment was seen in 27 patients (27.3%). Median follow-up was 25.3 months (IQR 8.9‒49.4), during which 25 (25.2%) patients died. The median number of VCD cycles received was 6 (IQR 4‒7). Most patients received weekly VCD (61.2%). Bi-weekly VCD was given in 38.8%, mainly as initial treatment (cycles 1-2). 22 patients (23.1%) received ≥8 cycles. Maintenance therapy was given in 24.7%. ΟRR was 83.6%, including CR 25.3% (23/91), VGPR 28.6% (26/91), and PR 29.7% (27/91). Stable disease occurred in 11% (10/91) and progressive disease in 5.5% (5/91). VCD produced rapid responses (median time to ≥PR: 2 cycles [range, 1-6]). We saw no difference in ORR in patients aged ≤75 vs. >75 years (P=0.845). Median OS was 62.7 months (IQR 28.9‒98.4); 2-year OS was 80.4%. Median PFS was 26.6 months (IQR 9.7‒46.6) and 18-month PFS 58.8%. We noted no difference in PFS between patients ≤75 years vs. > 75 years (P=0.999), ISS 3 vs. 1-2 (P=0.99), LDH (P=0.57), and CCI (P=0.70). Significant baseline risk-factors associated with OS in the multivariate analysis included ISS (HR 4.46, 95% CI 1.35‒14.7; P=0.014), PS (3.19, 1.02‒10; P=0.047), LDH (5.3, 1.16‒24.2; P=0.031), plasmacytomas (7.4, 1.8‒30.6; P=0.006), and amyloidosis (8.5, 1.37‒53; P=0.021). Subjectively VCD was well tolerated (7 patients discontinued VCD). Bortezomib dose was reduced in 23.9% (22/92). Grade ≥2 peripheral neuropathy occurred in 19.3% (19/98), grade 3/4 myelosuppression in 4.4% (4/91). Systematic G-CSF was used in 2 patients (2.2%). 42.4% of patients relapsed after VCD. Lenalidomide-dexamethasone was the most common second-line regimen (ORR 58.3%).
Conclusion
Our results show that VCD is a safe, feasible triplet for older patients with MM. It enables a high proportion of patients to achieve ≥VGPR (53%) and can be continued for >8 cycles for enhanced disease control. It is associated with long remissions (PFS 26.6 months) and may be given by nonintravenous route, which is particularly important for older patients.
Keyword(s): Bortezomib, Chemotherapy toxicity, Elderly, Multiple myeloma
Abstract: PB1681
Type: Publication Only
Session title: Myeloma and other monoclonal gammopathies - Clinical
Background
First-line treatment with VCD is well-studied in transplantation-eligible younger patients with MM (overall response rate [ORR] 83%, with 56% achieving ≥VGPR). Although VCD has not been approved by the European Medicines Agency for untreated older patients with MM, its use is recognized in the current ESMO guidelines. There have been few systematic studies of VCD in older patients with MM and data on its efficacy and safety is limited.
Aims
We did a retrospective, multicenter, cohort study of newly-diagnosed older patients with MM treated with VCD.
Methods
We identified all newly-diagnosed patients with MM aged ≥70 who were treated with VCD in six Greek hospitals between 2007-2020. We used Kaplan-Meier curves and Cox regression for the primary outcomes (overall survival [OS] and progression-free survival [PFS]).
Results
A total of 99 patients (52 men; 47 women) were included in our study. Median age was 76 years (range, 70-92). 16 patients (16.2%) aged ≥80 years. Performance status (PS) was ≥2 in 44 patients (50%). The median Charlson Comorbidity Index (CCI) was 4 (range, 2‒9); 51.6% had multimorbidity (CCI≥4). 46 patients (54.8%) had ISS 3 and 37 (37.8%) had high LDH. Renal impairment was seen in 27 patients (27.3%). Median follow-up was 25.3 months (IQR 8.9‒49.4), during which 25 (25.2%) patients died. The median number of VCD cycles received was 6 (IQR 4‒7). Most patients received weekly VCD (61.2%). Bi-weekly VCD was given in 38.8%, mainly as initial treatment (cycles 1-2). 22 patients (23.1%) received ≥8 cycles. Maintenance therapy was given in 24.7%. ΟRR was 83.6%, including CR 25.3% (23/91), VGPR 28.6% (26/91), and PR 29.7% (27/91). Stable disease occurred in 11% (10/91) and progressive disease in 5.5% (5/91). VCD produced rapid responses (median time to ≥PR: 2 cycles [range, 1-6]). We saw no difference in ORR in patients aged ≤75 vs. >75 years (P=0.845). Median OS was 62.7 months (IQR 28.9‒98.4); 2-year OS was 80.4%. Median PFS was 26.6 months (IQR 9.7‒46.6) and 18-month PFS 58.8%. We noted no difference in PFS between patients ≤75 years vs. > 75 years (P=0.999), ISS 3 vs. 1-2 (P=0.99), LDH (P=0.57), and CCI (P=0.70). Significant baseline risk-factors associated with OS in the multivariate analysis included ISS (HR 4.46, 95% CI 1.35‒14.7; P=0.014), PS (3.19, 1.02‒10; P=0.047), LDH (5.3, 1.16‒24.2; P=0.031), plasmacytomas (7.4, 1.8‒30.6; P=0.006), and amyloidosis (8.5, 1.37‒53; P=0.021). Subjectively VCD was well tolerated (7 patients discontinued VCD). Bortezomib dose was reduced in 23.9% (22/92). Grade ≥2 peripheral neuropathy occurred in 19.3% (19/98), grade 3/4 myelosuppression in 4.4% (4/91). Systematic G-CSF was used in 2 patients (2.2%). 42.4% of patients relapsed after VCD. Lenalidomide-dexamethasone was the most common second-line regimen (ORR 58.3%).
Conclusion
Our results show that VCD is a safe, feasible triplet for older patients with MM. It enables a high proportion of patients to achieve ≥VGPR (53%) and can be continued for >8 cycles for enhanced disease control. It is associated with long remissions (PFS 26.6 months) and may be given by nonintravenous route, which is particularly important for older patients.
Keyword(s): Bortezomib, Chemotherapy toxicity, Elderly, Multiple myeloma