Multiple myeloma in elderly patients: presenting features and outcome.
Few studies have been performed regarding multiple myeloma (MM) in elderly patients. We report a retrospective series of 130 unselected patients with MM aged 75 yr or more at diagnosis. Presenting features were identical to those reported in younger patients, except for a higher rate of infection. Heavy comorbidity was characteristic of unselected geriatric patients. Ninety-four patients received conventional chemotherapy. The response rate was 62%. Treatment toxicity was mild. Median survival was 22 months. Durie-Salmon (DS) clinical stages II and III MM were severe and often led to death, while significantly more patients with DS stage I MM died from unrelated causes (p<0.0001). Univariate analysis showed that age > or = 85 yr, performance status > or = 2, creatinine level > or = 120 micromol/l, beta 2 microglobulin level > 4 mg/l, C-reactive protein level > 6 mg/l, platelet count < 100 x 10(9)/l, presence of infection and lack of response to chemotherapy were adverse prognostic factors for survival. In Cox multivariate regression analysis, age > or = 85 yr (p<0.0001), performance status > or = 2 (p<0.0001) and creatinine level > or = 120 micromol/l (p<0.0001) were independent factors in predicting short survival. This study provides evidence that in patients with symptomatic MM age should not be considered as a major obstacle to active treatment. Prospective clinical trials are needed in this population of patients and should include an assessment of quality of life.
Rodon
P
P
Department of Internal Medicine and Haematology, Centre Hospitalier Général, Blois, France. rodon.philippe@wanadoo.fr
Linassier
C
C
Gauvain
J B
JB
Benboubker
L
L
Goupille
P
P
Maigre
M
M
Luthier
F
F
Dugay
J
J
Lucas
V
V
Colombat
P
P
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D002423:Cause of Death; D015897:Comorbidity; D003520:Cyclophosphamide / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D016898:Interferon-alpha / Q000008:administration & dosage; D015993:Life Tables; D008130:Lomustine / Q000008:administration & dosage; D008297:Male; D008558:Melphalan / Q000008:administration & dosage; D009101:Multiple Myeloma / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D009194:Myeloma Proteins / Q000032:analysis; D009367:Neoplasm Staging; D010257:Paraneoplastic Syndromes / Q000453:epidemiology; D011238:Prednimustine / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
D016898:Interferon-alpha; D009194:Myeloma Proteins; D014750:Vincristine; D005047:Etoposide; D008130:Lomustine; D003907:Dexamethasone; D004317:Doxorubicin; D003520:Cyclophosphamide; D011238:Prednimustine; D008558:Melphalan; D011241:Prednisone