Analysis of clinical features, treatment response, and prognosis among 61 elderly newly diagnosed multiple myeloma patients: a single-center report

World Journal of Surgical Oncology

Zhongxia Huang¹  Shilun Chen¹  Man Shen¹  Xin Li¹  Na An¹ 

[1] Multiple myeloma medical center of Beijing, Department of Hematology, Beijing Chao-yang Hospital, Capital Medical University, 5 Jingyuan Road, Shijingshan District, Beijing 100043, China

关键词: Overall survival;    Bortezomib;    Elderly patients;    Multiple myeloma;   

Others  :  1223986
DOI  :  10.1186/s12957-015-0649-8

 received in 2015-03-03, accepted in 2015-07-14,  发布年份 2015

【 摘 要 】

Background

We identified the clinical features of 61 cases of multiple myeloma (MM) patients over 65 years and analyzed the treatment and prognosis of the era of new drugs in elderly patients.

Methods

We identified 61 newly diagnosed symptomatic multiple myeloma (NDMM) among elderly Chinese patients more than 65 years old diagnosed from 2006 to 2012.

Results

Of the 205 consecutive MM patients whom we reviewed, 61 (29.76 %) cases were NDMM patients aged more than 65 years and the others were younger than 65 years old. Among them, 40 (65.6 %) cases were in end-stage (ISS stage III); meanwhile, 19 (31.2 %) cases of them had MM with extramedullary plasmacytoma (EMP), observed in 42.1 % patients at diagnosis, and the top three incidence of position were spinal canal, pleural, and soft tissue. In the whole column, the median follow-up was 38 months and median age was 72.5 years. Patients received bortezomib- or thalidomide-containing regimens as initial therapy. Comparing the two treatment groups, the complete remission (CR)/near-complete remission (nCR) rate was significantly higher in the bortezomib-containing regimens (61.5 vs.18.18 %, P = 0.001), no difference in progression-free survival (PFS) and overall survival (OS). Patients of age over 75 years had shorter OS than those of age over 65 years (49 vs. 24 months, P = 0.001). The patients with EMP had shorter OS than those without EMP in two age groups (32 vs. 42 and 15 vs. 24 months, P = 0.017 and 0.024, respectively).

Conclusions

The results highlight that patients over 75 years and MM with EMP have a poorer outcome. While the CR rate is higher in bortezomib-containing regimens, no significant improvement is noted in respect to the survival outcomes; also, it cannot overcome the negative influence on survival of age and MM with EMP in elderly patients.

【 授权许可】

   
2015 An et al.

【 图 表 】

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【 参考文献 】

• [1]Kyle RA, Rajkumar SV. Multiple myeloma. Blood. 2008; 111(6):2962-2972.
• [2]Kim K, Lee JH, Kim JS, Min CK, Yoon SS, Shimizu K et al.. Clinical profiles of multiple myeloma in Asia-An Asian Myeloma Network study. Am J Hematol. 2014; 89(7):751-756.
• [3]Lee JH, Lee DS, Lee JJ, Chang YH, Jin JY, Jo DY et al.. Multiple myeloma in Korea: past, present, and future perspectives. Experience of the Korean multiple myeloma working party. Int J Hematol. 2010; 92(1):52-7.
• [4]Huang SY, Yao M, Tang JL, Lee WC, Tsay W, Cheng AL et al.. Epidemiology of multiple myeloma in Taiwan: increasing incidence for the past 25 years and higher prevalence of extramedullary myeloma in patients younger than 55 years. Cancer. 2007; 110(4):896-905.
• [5]Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, Kapoor P, Dingli D, Hayman SR, Leung N, Lust J, McCurdy A, Russell SJ, Zeldenrust SR, Kyle RA, Rajkumar SV. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia. 2014; 28(5):1122-8.
• [6]Bringhen S, Mateos MV, Zweegman S, Larocca A, Falcone AP, Oriol A et al.. Age and organ damage correlate with poor survival in myeloma patients: meta-analysis of 1435 individual patient data from 4 randomized trials. Haematologica. 2013; 98:980-987.
• [7]Zhang J, Zhong Y. Clinical analysis of 36 multiple myeloma patients with extramedullary plasmacytoma invasion of the spinal canal. Hematol Oncol. 2014.
• [8]An G, Xu Y, Shi L, Shizhen Z, Deng S, Xie Z et al.. Chromosome 1q21 gains confer inferior outcomes in multiple myeloma treated with bortezomib but copy number variation and percentage of plasma cells involved have no additional prognostic value. Haematologica. 2014; 99(2):353-359.
• [9]Chen HF, Wu TQ, Li ZY, Shen HS, Tang JQ, Fu WJ et al.. Extramedullary plasmacytoma in the presence of multiple myeloma: clinical correlates and prognostic relevance. Onco Targets Ther. 2012; 5:329-34.
• [10]Palumbo A, Mina R. Management of older adults with multiple myeloma. Blood Rev. 2013; 27:133-142.
• [11]Fayers PM, Palumbo A, Hulin C, Waage A, Wijermans P, Beksaç M et al.. Thalidomide for previously untreated elderly patients with multiple myeloma: meta-analysis of 1685 individual patient data from 6 randomized clinical trials. Blood. 2011; 118(5):1239-1247.
• [12]Mateos MV, Richardson PG, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O et al.. Bortezomib plus melphalan and prednisone compared with melphalan and prednisone in previously untreated multiple myeloma: updated follow-up and impact of subsequent therapy in the phase III VISTA trial. J Clin Oncol. 2010; 28:2259-2266.
• [13]San Miguel JF, Schlag R, Khuageva NK, Dimopoulos MA, Shpilberg O, Kropff M et al.. Bortezomib plus melphalan and prednisone for initial treatment of multiple myeloma. N Engl J Med. 2008; 359:906-917.
• [14]Mateos MV, Oriol A, Martínez-López J, Gutiérrez N, Teruel AI, de Paz R et al.. Bortezomib, melphalan, and prednisone versus bortezomib, thalidomide, and prednisone as induction therapy followed by maintenance treatment with bortezomib and thalidomide versus bortezomib and prednisone in elderly patients with untreated multiple myeloma: a randomised trial. Lancet Oncol. 2010; 11:934-941.
• [15]Bringhen S, Mateos MV, Zweegman S, Larocca A, Falcone AP, Attal M et al.. Chromosomal abnormalities are major prognostic factors in elderly patients with multiple myeloma: the intergroupe francophone du myélome experience. J Clin Oncol. 2013; 31:2806-2809.
• [16]Gay F, Larocca A, Wijermans P, Cavallo F, Rossi D, Schaafsma R et al.. Complete response correlates with long-term progression-free and overall survival in elderly myeloma treated with novel agents: analysis of 1175 patients. Blood. 2011; 117:3025-3031.
• [17]Morabito F, Bringhen S, Larocca A, Wijermans P, Victoria Mateos M, Gimsing P et al.. Bortezomib, melphalan, prednisone (VMP) versus melphalan, prednisone, thalidomide (MPT) in elderly newly diagnosed multiple myeloma patients: a retrospective case-matched study. Am J Hematol. 2014; 89:355-362.
• [18]Mikhael JR, Dingli D, Roy V, Reeder CB, Buadi FK, Hayman SR et al.. Management of newly diagnosed symptomatic multiple myeloma: updated Mayo Stratification of Myeloma and Risk-Adapted Therapy (mSMART) consensus guidelines 2013. Mayo Clin Proc. 2013; 88:360-376.
• [19]Palumbo A, Bringhen S, Ludwig H, Dimopoulos MA, Bladé J, Mateos MV et al.. Personalized therapy in multiple myeloma according to patient age and vulnerability: a report of the European Myeloma Network (EMN). Blood. 2011; 118:4519-4529.