title: Improved survival of older patients with multiple myeloma in the era of novel agents.
abstract: Multiple myeloma (MM) is the most common hematologic malignancy in Europe. Although remaining an incurable disease, substantial progress has been made within the last two decades. However, until recently, improvement in overall survival (OS) was only documented in younger, transplant-eligible patients. In this analysis, we retrospectively investigated the outcome of older patients with newly diagnosed MM in an unselected patient population with a special focus on the use of novel agents in a routine care community-based, non-university setting. A total of 107 patients older than 65 years of age or patients aged 60-65 years with relevant comorbidities precluding the use of autologous stem cell transplantation diagnosed with MM between 2000 and 2011 at the two largest non-university hospitals of Eastern Switzerland were analyzed. Patients were grouped into two six-year periods by date of initial diagnosis, 2000-2005 and 2006-2011. The median follow-up was 6.9 (range of 2.1 to 9.4) years. The median OS for the entire cohort was 3.0 years (95% confidence interval, 2.4-4.4). The median OS was significantly longer for patients in the 2006-2011 group (4.3 years) compared with the 2000-2005 group (2.6 years, p = 0.04). The 5-year estimated OS improved from 26% to 38%; 1-year survival was similar in both groups (86% in the 2000-2005 group and 84% in the 2006-2011 group respectively). The use of novel agents showed a statistically significant correlation with OS, whereas the impact of age was only of borderline significance. In conclusion, we demonstrate improved OS outcomes in an unselected population of older patients with MM during the last decade. This improvement is associated with an increased use of novel agents for the treatment of transplant-ineligible MM patients in daily clinical practice. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Medical Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland.
authors.forename: Ulrich J M
authors.initials: UJ
authors.lastname: Mey
authors.affiliation: Medical Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland.|Departement of Internal Medicine V, Hematology/Oncology, University Hospital Innsbruck, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Leitner
authors.affiliation: Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Driessen
authors.affiliation: Medical Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland.
authors.forename: Richard
authors.initials: R
authors.lastname: Cathomas
authors.affiliation: Statistics Unit, SAKK Swiss Group for Cancer Research Coordinating Center, Bern, Switzerland.
authors.forename: Dirk
authors.identifier: http://orcid.org/0000-0002-9914-0243
authors.initials: D
authors.lastname: Klingbiel
authors.affiliation: Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
authors.forename: Felicitas
authors.initials: F
authors.lastname: Hitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D064592:Autografts; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000401:mortality* / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate
keywords: multiple myeloma; novel agents; older; outcome