Prescription Patterns and Outcomes of First-Line Therapy for Non-Transplant Eligible Multiple Myeloma Real-Life Patients According to Age: A Retrospective Analysis of the 2012-2016 Period

Background

Multiple myeloma (MM) affects elderly individuals with two-thirds of patients aged >65 years at diagnosis, 35% ≥75 and 10% ≥80. In general, routine clinical practice is based on the results of large, multicenter, randomized clinical trials. However, despite efforts from cooperative groups, patients enrolled in trials are generally younger and presumably healthier than the typical older patient with MM. Aims To describe prescription patterns for first-line treatment of non-transplant eligible MM

Methods

Retrospective analysis of newly diagnosed MM patients not eligible for transplantation, who started anti-myeloma treatment between 2012-2016 in 20 Spanish hospitals. Variables collected included patients' characteristics at diagnosis (ECOG, laboratory parameters, ISS, and cytogenetics/fluorescent in situ hybridization), characteristics of first-line treatment, overall survival (OS), progression-free survival (PFS), and overall response rate (ORR), defined as partial response or better.

Results

The retrospective cohort included 421 patients with a median age of 76 years (41-90); 203 (49%), 106 (26%), and 104 (25%) were ≤75, 76-80, and >80 years old, respectively; 28 (12%) had ECOG >2. ISS staging was I, II, III in 57 (18%), 93 (30%), and 160 (52%) patients, respectively; 73 (25%) patients had high-risk cytogenetics. The most frequently prescribed regimen was VMP (n=208), followed by other bortezomib-based regimens (n=130), melphalan (n=44), lenalidomide (n=19), and other (n=20).

Conclusion

In real-life practice, there is high variability in treatment regimens, being bortezomib-based the most frequently prescribed regimens in the study period. Besides the clinical characteristics of MM patients, age influenced survival in our cohort of real-life patients, suggesting that treatment choice for elderly patients should be based on a specific pre-treatment assessment of risks and benefits.

Keywords

Elderly

Multiple myeloma

Real-World Data

Tracks

Treatment of Newly Diagnosed Myeloma Non-Transplant