Age and the treatment of multiple myeloma. Southeastern Cancer Study Group experience

To determine the impact of age upon the response to treatment, survival, and toxicity of chemotherapy for multiple myeloma, the results of a large cooperative group trial were examined. Patients were randomly assigned to induction therapy with either carmustine, cyclophosphamide, and prednisone or melphalan and prednisone; patients with response received two years of treatment. The age distribution of patients in this trial compared with the incidence figures from the Surveillance Epidemiology and End Results (SEER) study shows a degree of under-representation of the oldest patient groups. Prognostic factors were evenly distributed over the age range and treatment groups. Older patients had responses and survival rates equivalent to younger patients and with both treatment regimens regardless of prognostic factor characteristics. Hematologic toxicity was no greater for the older group in either regimen despite the presence of a nitrosourea in one. Gastrointestinal toxicity was increased in the older patients who received the regimen of melphalan and prednisone. The study suggests that in myeloma and perhaps other such chemotherapy-responsive malignancies treated with moderately intense chemotherapy, without bone marrow ablation, elderly and younger patients have similar outcomes.