Multiple Myeloma in Patients over 80: A Real World Retrospective Study of First Line Conservative Approach with Bortezomib Dexamethasone Doublet Therapy and Mini-Review of Literature
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Patients
2.2. Treatment
2.3. Geriatric Assessment
2.4. Outcomes
2.5. Statistical Analysis
3. Results
3.1. Response
3.2. PFS and OS
3.3. Tolerability and Safety
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Baseline Characteristics | n = 74 | % |
---|---|---|
Median age (years) | 85 (80–95) | - |
Woman | 40 | 54 |
Myeloma type | ||
IgG | 48 | 65 |
IgA | 10 | 13 |
Light chains | 16 | 22 |
Hemoglobin < 10 g/dL | 64 | 86 |
Calcium > 2.75 mmol/L | 19 | 26 |
Clearance Cockcroft < 30 mL/min | 34 | 46 |
GFR CKD EPI < 30 mL/min/1.73 m2 | 25 | 34 |
Bone damage | 40 | 54 |
Performance Status | ||
<3 | 31 | 42 |
≥3 | 43 | 58 |
Arterial hypertension | 49 | 66 |
Chronic Heart Failure | 6 | 8 |
Ischemic heart disease | 8 | 11 |
Atrial fibrillation | 14 | 19 |
Valvular heart disease | 5 | 7 |
Diabetes | 12 | 16 |
Chronic Kidney Failure | 13 | 18 |
Chronic respiratory deficiencies | 7 | 9 |
Cognitive disorders | 11 | 15 |
History of Stroke | 5 | 7 |
Albumin < 35 g/L | 41 | 55 |
ADL | ||
<4.5 | 23 | 31 |
≥4.5 | 51 | 69 |
Walking with assistance | ||
Without | 45 | 61 |
With | 29 | 39 |
Body Mass Index | ||
<21 kg/m2 | 19 | 25.7 |
≥21 kg/m2 | 55 | 74.3 |
Age-adjusted Charlson Comorbidity Index | ||
<5 | 18 | 24 |
≥5 | 56 | 76 |
Response Assessment | n = 74 | % |
---|---|---|
Therapeutic responses after induction | ||
VGPR | 14 | 19 |
PR | 34 | 45.9 |
MR | 13 | 17.6 |
SD | 3 | 4 |
PD | 1 | 1.3 |
Not evaluated | 9 | 12.2 |
Overall response rate (CR + VGPR + PR) | 64.9% | |
Best response during treatment | ||
VGPR | 25 | 33.8 |
PR | 29 | 39.2 |
MR | 4 | 5.4 |
SD | 6 | 8.1 |
PD | 1 | 1.3 |
Not evaluated | 9 | 12.2 |
Overall response rate (CR + VGRP + PR) | 73% |
Prognostic Factors | OS | PFS | ||
---|---|---|---|---|
HR (95% CI) | p Value | HR (95% CI) | p Value | |
Sex (female vs. male) | 0.94 (0.53 to 1.67) | 0.82 | 0722 (0.40 to 1.28) | 0.23 |
Age-Adjusted CCI (>5 vs. < 5) | 1.12 (0.58 to 2.15) | 0.74 | 1.04 (0.53 to 2.03) | 0.91 |
ECOG PS (≥3 vs. <2) | 2.88 (1.61 to 5.15) | 0.0002 * | 2.13 (1.24 to 3,66) | 0.0027 * |
Heart disease | 1.38 (0.76 to 2.51) | 0.26 | 1.54 (0.84 to 2.84) | 0.14 |
Neurological disease | 0.70 (0.36 to 1.40) | 0.34 | 0.76 (0.38 to 1.53) | 0.48 |
Lung disease | 1.43 (0.54 to 3.83) | 0.41 | 1.00 (0.43 to 2.36) | 0.99 |
Comorbidities > 3 vs. <3 | 1.16 (0.65 to 2.05) | 0.62 | 1.08 (0.61 to 1.92) | 0.79 |
Albumin < 35 g/L vs. >35 g/L | 1.15 (0.65 to 2.04) | 0.62 | 1.32 (0.45 to 2.33) | 0.34 |
Hemoglobin < 10 g/dL vs. >10 g/dL | 1.33 (0.61 to 2.89) | 0.51 | 1.08 (0.52 to 2.24) | 0.83 |
Calcium > 2.75 mmol/L vs. <2.75 mmol/L | 0.71 (0.37 to 1.34) | 0.33 | 0.77 (0.40 to 1.47) | 0.46 |
Creatinine level > 177 µmol/L vs. <177 µmol/L | 1.42 (0.72 to 2.80) | 0.23 | 1.60 (0.79 to 3.24) | 0.13 |
Clearance Cockcroft < 30 mL/min vs. >30 mL/min | 1.20 (0.67 to 2.13) | 0.53 | 0.78 (0.46 to 1.33) | 0.86 |
GFR CKD < 30 mL/min vs. >30 mL/min | 1.54 (0.81 to 2.94) | 0.14 | 1.46 (0.79 to 2.69) | 0.16 |
ADL < 4.5 vs. >4.5 | 3.16 (1.26 to 7.93) | 0.0002 * | 2.0 (1.074 to 3.72) | 0.0328 * |
BMI < 21 vs. ≥21 | 1.89 (0.95 to 3.73) | 0.028 * | 1.28 (0.70 to 2.33) | 0.39 |
Walking without assistance vs. with assistance | 2.01 (0.87 to 4.67) | 0.0033 * | 1.61 (0.92 to 2.84) | 0.073 |
n = 74 | |
---|---|
Median number of bortezomib cycle | 9 |
Total number of bortezomib cycle | - |
<5 | 21 |
5–10 | 28 |
>10 (maximum 25) | 25 |
Bortezomib dose adaptation | n = 53 (71.6%) |
1 mg/m2 | 53 (71.6%) |
0.7 mg/m2 | 34 (46%) |
Dexamethasone interruption | n = 10 (14.3%) |
Temporary | 1 (1.3%) |
Permanent | 9 (12%) |
Study | No. of Patients | Median Age (Years) | PS ≥ 3 | Treatment | ORR (%) | PFS (Median, Months) | OS (Median, Months) | |
---|---|---|---|---|---|---|---|---|
Prospective | Upfront [25] | 502 | 73 | 0 | Vd/VTD/VMP | 73/80/70 | 14.7/15.4/17.3 | 49.8/51.5/53.1 |
Vista [1] | 682 | 71 | 0 | VMP/MP | 71/35 | 24/11.6 | NA/43 | |
First [2] | 1623 | 73 | 0.006 | Rd/MPT | 75/62 | 25.5/21.2 | 59.1/49.1 | |
Larocca [14] | 152 | 78 | 0 | VP/VCP/VMP | 64/67/86 | 14/15.2/17.1 | 60/70/76% at 24 months | |
O’Donnel [15] | 50 | 73 | 0 | VRD lite | 86 | 35.1 | Not reached | |
SWOG [3,4] | 525 | 63 | 0 | VRd/Rd | 82/72 | 41/29 | Not Reached/69 | |
ALCYONE [5,6] | 706 | 71 | 0 | DVMP/VMP | 90.9/73.9 | 36.4/19.3 | Not reached | |
MAIA [7] | 737 | 74 | 0 | DRd/Rd | 92.9/81.3 | Not Reached/31.9 | 70.6/55.6% at 30 months | |
Larocca [16] | 199 | 75 | 0 | Rd/Rd-R | 78/68 | 20.2/18.3 | 74/63% at 36 months | |
Stege [24] | 65 | 81 | 8 | DIxd | 78 | 13.8 | 62% at 22.9 months | |
Retrospective | Our study | 74 | 85 | 58 | Vd | 73 | 13.2 | 26.9 |
Matsue [19] | 42 | 85 | 52.4 | Bortezomib +ImiD based | 88.1 | 19.1 | 31.9 | |
Ediriwickrama [23] | 52 | 79 | 25 | T/Vd/Rd | 70 | NR | 36 | |
Chan [20] | 155 | 76 | NR | VCD | 79.4 | 21.7 | 45.1 | |
Gavriatopoulo [22] | 110 | 83 | 66 | VR/V/R | 63 | 7 | 21 | |
Panistas [21] | 89 | 87 | NR | Bortezomib +ImiD based | NR | 11.7 | 22.2 | |
Dimopoulos [22] | 155 | 82 | <60 | Bortezomib +ImiD based | 58 | NR | 22 | |
Bang [18] | 139 | 80 | <32 | Bortezomib +ImiD based | 51 | 20 | 27 | |
Medhekar [26] | 2342 | 67 | >3.4 | VRd | NR | 26.5 | NR |
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Huynh, L.; Birsen, R.; Mora, L.; Couderc, A.-L.; Mitha, N.; Farcet, A.; Chebib, A.; Chaibi, P. Multiple Myeloma in Patients over 80: A Real World Retrospective Study of First Line Conservative Approach with Bortezomib Dexamethasone Doublet Therapy and Mini-Review of Literature. Cancers 2022, 14, 4741. https://doi.org/10.3390/cancers14194741
Huynh L, Birsen R, Mora L, Couderc A-L, Mitha N, Farcet A, Chebib A, Chaibi P. Multiple Myeloma in Patients over 80: A Real World Retrospective Study of First Line Conservative Approach with Bortezomib Dexamethasone Doublet Therapy and Mini-Review of Literature. Cancers. 2022; 14(19):4741. https://doi.org/10.3390/cancers14194741
Chicago/Turabian StyleHuynh, Laurence, Rudy Birsen, Lucie Mora, Anne-Laure Couderc, Nathalie Mitha, Anaïs Farcet, Amale Chebib, and Pascal Chaibi. 2022. "Multiple Myeloma in Patients over 80: A Real World Retrospective Study of First Line Conservative Approach with Bortezomib Dexamethasone Doublet Therapy and Mini-Review of Literature" Cancers 14, no. 19: 4741. https://doi.org/10.3390/cancers14194741
APA StyleHuynh, L., Birsen, R., Mora, L., Couderc, A. -L., Mitha, N., Farcet, A., Chebib, A., & Chaibi, P. (2022). Multiple Myeloma in Patients over 80: A Real World Retrospective Study of First Line Conservative Approach with Bortezomib Dexamethasone Doublet Therapy and Mini-Review of Literature. Cancers, 14(19), 4741. https://doi.org/10.3390/cancers14194741