title: Treatment of multiple myeloma in elderly people: long-term results in 178 patients.
abstract: The purposes of the present study have been to analyse the presenting features, response to therapy and survival of myeloma patients aged 70 years or more, in comparison to younger patients. From January 1985 to December 1989, 487 patients with multiple myeloma (MM) were randomized to receive melphalan and prednisone (MP) versus alternating cycles of vincristine, cyclophosphamide, melphalan, and prednisone (VCMP) and vincristine, BCNU, adriamycin, and prednisone (VBAP). The subset of 178 patients who were 70 or more years is the subject of this study, whereas the 309 patients younger than 70 years were used as a control group. The presenting features and response to chemotherapy of older patients were no different to those of the younger population. However, the survival of elderly patients was significantly shorter (median 23.4 vs. 33.5 months, p < 0.001). The overall response rate to MP in older patients was 50% (28% objective plus 22% partial response) compared with 61% (44% objective plus 17% partial response) to combination chemotherapy (p = not significant). Myelosuppression was moderate in both arms, although MP produced a higher degree of thrombocytopenia. There were no significant differences in survival between patients given MP versus VCMP/ VBAP (median, 20 vs. 27 months, p = 0.2). Response to treatment was associated with a significantly longer survival. Older patients with symptomatic myeloma tolerate chemotherapy and should be offered treatment.
authors.affiliation: Hematology Unit, Hospital Clinic, Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bladé
authors.forename: M
authors.initials: M
authors.lastname: Muñoz
authors.forename: M
authors.initials: M
authors.lastname: Fontanillas
authors.forename: J
authors.initials: J
authors.lastname: San Miguel
authors.forename: A
authors.initials: A
authors.lastname: Alcalá
authors.forename: J
authors.initials: J
authors.lastname: Maldonado
authors.forename: C
authors.initials: C
authors.lastname: Besses
authors.forename: M J
authors.initials: MJ
authors.lastname: Moro
authors.forename: J
authors.initials: J
authors.lastname: García-Conde
authors.forename: C
authors.initials: C
authors.lastname: Rozman
authors.forename: E
authors.initials: E
authors.lastname: Montserrat
authors.forename: J
authors.initials: J
authors.lastname: Estapé
mesh_terms: D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002330:Carmustine / Q000008:administration & dosage / Q000009:adverse effects; D002423:Cause of Death; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000009:adverse effects; D009101:Multiple Myeloma / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011379:Prognosis; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D008558:Melphalan; D002330:Carmustine; D011241:Prednisone