title: The outcomes of newly diagnosed elderly multiple myeloma patients treated at a single U.S. institution.
abstract: Improvements in the outcomes of elderly multiple myeloma (MM) patients have lagged behind those of transplant-eligible patients, likely due in part to the use of less efficacious melphalan-containing regimens. To date, there are very limited data for the outcomes of elderly MM patients in the United States (US), particularly for novel agent-containing triplet regimens. In this retrospective study at a single U.S. institution, the outcomes of 117 consecutive newly diagnosed, symptomatic MM patients over the age of 70 were evaluated. The median age was 75 years (range 70-95) with significant baseline comorbidities including 36% cardiac and 20% renal (CrCl < 30 mL/min). The median follow-up was 43 months and the median number of lines of therapy during the study period was 2 (1-7). Eighty-six patients (83%) received non-melphalan doublet, triplet, or quadruplet initial therapy, most with significant planned dose attenuations. For those treated with dose-attenuated RVD (n = 34), the outcomes were particularly impressive with overall response rate (ORR), complete remission and very good partial remission (CR + VGPR), and progression-free survival (PFS) of 94%, 65%, and 36 months, respectively, and overall survival (OS) not reached. The PFS with RVD was significantly greater than that of all other regimens (P = 0.030), including RD.
authors.affiliation: Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York City, New York, 10029.
authors.forename: Lauren
authors.initials: L
authors.lastname: Bonomo
authors.affiliation: Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York City, New York, 10029.
authors.forename: Jerry
authors.initials: J
authors.lastname: Lue
authors.affiliation: Division of Hematology Oncology, Icahn School of Medicine at Mount Sinai, Gustave Levy Place, Box 1185, New York City, New York, 10029.
authors.forename: Sundar
authors.initials: S
authors.lastname: Jagannath
authors.affiliation: Division of Hematology Oncology, Icahn School of Medicine at Mount Sinai, Gustave Levy Place, Box 1185, New York City, New York, 10029.
authors.forename: Ajai
authors.initials: A
authors.lastname: Chari
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008558:Melphalan / Q000008:administration & dosage / Q000627:therapeutic use; D009101:Multiple Myeloma / Q000188:drug therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
chemical_list: D000970:Antineoplastic Agents; D008558:Melphalan
keywords: Chemotherapy; United States; elderly; myeloma; neoplasms; plasma cell