title: Multiple myeloma in octogenarians: clinical features and outcome in the novel agent era.
abstract: BACKGROUND
  Multiple myeloma (MM) affects mainly elderly persons and because the population of octogenarians increases, it is common to treat patients ≥ 80 years of age. These patients are often not included in clinical trials; thus, there is limited data on their characteristics and treatment outcome.
  
  
  METHODS
  We retrospectively analyzed 682 consecutive, unselected patients with newly diagnosed symptomatic myeloma who started treatment between January 1, 2003 and December 31, 2010.
  
  
  RESULTS
  We identified 155 (23%) patients ≥ 80 years of age. Compared to patients <80 years, octogenarians had poorer performance status (P < 0.001), anemia (P = 0.006), low serum albumin (P = 0.001), and advanced ISS (P < 0.001). The median survival of patients ≥ 80 years was 22 months, and 14% died within 2 months from therapy initiation. The median survival of patients ≥ 80 years who received upfront novel agents was 26 vs. 17 months for those who did not. ECOG performance status ≤ 1 and frontline use of novel agents were independently associated with better survival. Response to first-line therapy was associated with improved survival (29 vs. 16 months, P = 0.017).
  
  
  CONCLUSIONS
  Patients ≥ 80 years of age present with features of advanced myeloma and impaired performance status. The addition of novel agents may improve their outcome, but careful assessment and prospective clinical trials targeting the population of elderly patients are needed.
authors.affiliation: Department of Clinical Therapeutics, University of Athens School of Medicine, Athens, Greece. mdimop@med.uoa.gr
authors.forename: Meletios A
authors.initials: MA
authors.lastname: Dimopoulos
authors.forename: Efstathios
authors.initials: E
authors.lastname: Kastritis
authors.forename: Sossana
authors.initials: S
authors.lastname: Delimpasi
authors.forename: Eirini
authors.initials: E
authors.lastname: Katodritou
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Hatzimichael
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Kyrtsonis
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Repousis
authors.forename: Maria
authors.initials: M
authors.lastname: Tsirogianni
authors.forename: Zafiris
authors.initials: Z
authors.lastname: Kartasis
authors.forename: Agapi
authors.initials: A
authors.lastname: Parcharidou
authors.forename: Michalis
authors.initials: M
authors.lastname: Michael
authors.forename: Eurydiki
authors.initials: E
authors.lastname: Michalis
authors.forename: Constantinos
authors.initials: C
authors.lastname: Tsatalas
authors.forename: Ekaterini
authors.initials: E
authors.lastname: Stefanoudaki
authors.forename: Eudoxia
authors.initials: E
authors.lastname: Hatjiharissi
authors.forename: Dimitra
authors.initials: D
authors.lastname: Gika
authors.forename: Argiris
authors.initials: A
authors.lastname: Symeonidis
authors.forename: Evangelos
authors.initials: E
authors.lastname: Terpos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zervas
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D009101:Multiple Myeloma / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome