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Multiple myeloma in elderly patients: presenting features and outcome
P Rodon1, C Linassier, J B Gauvain
1Department of Internal Medicine and Haematology, Centre Hospitalier Général, Blois, France. rodon.philippe@wanadoo.fr
Abstract:
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.
Insights
Elderly patients with multiple myeloma (MM) aged 75+ can tolerate conventional chemotherapy, showing a 62% response rate. Age over 85, poor performance status, and high creatinine are key predictors of shorter survival.
Area of Science:
- Hematology
- Geriatric Medicine
- Oncology
Background:
- Multiple myeloma (MM) is a hematologic malignancy primarily affecting older adults.
- Limited data exists on the characteristics and outcomes of MM in patients aged 75 years and older.
Purpose of the Study:
- To evaluate the clinical presentation, treatment response, toxicity, survival, and prognostic factors in elderly patients (≥75 years) diagnosed with multiple myeloma.
Main Methods:
- Retrospective analysis of 130 unselected patients with MM aged 75 years or more at diagnosis.
- Patients received conventional chemotherapy; response rates, toxicity, and survival were assessed.
- Prognostic factors for survival were analyzed using univariate and Cox multivariate regression.
Main Results:
- Presenting features were similar to younger patients, with a higher infection rate and significant comorbidity.
- Sixty-two percent of patients receiving chemotherapy responded, with mild treatment toxicity.
- Median survival was 22 months. Age ≥85, performance status ≥2, and creatinine ≥120 µmol/L were independent predictors of short survival.
Conclusions:
- Age alone should not preclude active treatment for symptomatic multiple myeloma in elderly patients.
- Further prospective trials are warranted to assess treatment efficacy and quality of life in this population.