Relapsed/refractory multiple mieloma treatment in elderly patients

• Autores: Virginia Benito Ibáñez, María Paz Espinosa Pérez, Beatriz Cuevas Ruiz, Jorge Labrador
• Localización: European journal of clinical pharmacy: atención farmacéutica, ISSN 2385-409X, Vol. 20, Nº. 4, 2018, págs. 213-216
• Idioma: inglés
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• Resumen

  • Objective: Most of the patients diagnosed with multiple myeloma (MM) are ineligible for transplant (median age 67 years). Despite the number of therapeutic options available, patients will eventually relapse. The few clinical trials data and the comorbidities in elderly patients make difficult the therapy pathway. The aim of this study is to evaluate effectiveness and safety in non-candidate transplant patients with relapsed or refractory (R/R) MM. Method: A two-year retrospective observational study (July 2014-July 2016). Comorbidities were evaluated with Charlson Comorbidity Index (CCI). Survivals were calculated using the Kaplan-Meier method. Toxicities were evaluated according to Common Terminology Criteria for Adverse Events (CTCAE). Results: The study included 22 patients (8 women), median age 75 years (66-84). Median line of treatment: 3 (2-5). There were five switches because of adverse events. Most frequent first-line was bortezomib combination therapy (95.4%). Second-line, lenalidomide-dexamethasone (86.4%). Median CCI: 4.3 (age-adjust 6.3). Median progression free survival (PFS) in 1-5 line were respectively: 7.7 months; 22.4; 2.4; 4.6; 1.6. Median overal survival (OS) since the day of diagnose was 57.8 months. Most frequent cause of delay in administration was infection. The frequency of some of the hematological adverse effects was higher for bortezomib and lena-lidomide than in clinical trials. Conclusions: Lenalidomide achieved good results, even better than first-line therapy, with an acceptable toxicity profile. More studies are required to define frailty profiles and personalize treatments