Cancer Med: First-line treatment outcomes and clinical outcomes in older multiple myeloma patients in real-world settings: a multicenter retrospective study in China.

The use of proteasome inhibitors (PI), new immunomodulators (IMiDs) and other new drugs, as well as high-dose chemotherapy combined with autologous stem cell transplantation, has greatly improved the survival rate
of young patients with multiple myeloma (MM).
However, the improvement in survival in older patients remains insufficient
.
The best treatment recommendation model for older MM patients has not been developed, especially with little
research in the real world.

A team retrospectively analyzed the treatment patterns and outcomes
of 328 Chinese MM patients (≥ 65 years old) in real-world settings.
The median age of this cohort was 70 years
.
Patients were divided into Group 1 (PI-based protocol, n = 218), Group 2 (MID-based protocol, n = 48), and Group 3 (PI + IMiDs, n = 62).

The induction protocol in group 3 produced a higher overall response rate than groups 1 and 2 (85.
42% vs.
71.
08% vs.
66.
67%, p = 0.
016).

The median follow-up for this cohort was 30 ([IQR] 18-36) months
.
For the entire cohort, the median progression-free survival (PFS) was 26 (IQR 12.
00-42.
89) months and overall survival (OS) was 60 (IQR 40.
00-67.
20) months
.

Figure 1: Survival curves
of elderly MM patients treated with different first-line induction regimens.
(A) The median PFS of patients in Group 1 (n = 219, PI), Group 2 (n = 42, IMiDs), and Group 3 (n = 68, PI + IMiD) was 28, 18, and 26 months
, respectively.
There was no significant difference between the three groups of PFAs (p = 0.
182).

(B) The median OS of patients in groups 1, 2 and 3 was 60 months and 59 months, which was not reached
.
No significant differences were found in the operating systems between the three groups (p = 0.
067).

immunomodulators, immunomodulators; MM, multiple myeloma; operating system, overall survival; PFS, progression-free survival; PI, proteasome inhibitors

Figure 2: Survival curves
of elderly patients in different maintenance treatment groups.
(A) Patients not receiving maintenance therapy (n = 56) had a median PFS of 26 months
.
Patients receiving maintenance therapy had a median PFS of 48 months
(n = 129).
There was a statistically significant difference in PFS between the two groups (p = 0.
016).

(B) The median OS for patients not receiving maintenance therapy was 40 months
.
The median OS
of patients receiving maintenance therapy was not reached.
There was a significant difference in OS between the two groups (p = 0.
007).

operating system, overall survival; PFS, progression-free survival

Figure 3: Survival curves
of MM patients in different age groups.
(A) Median PFS for patients aged 65-70 years (n = 166), 71-79 years (n = 117), and ≥ 80 years (n = 24), respectively, were 31, 23, and 14 months
.
PFS was significantly different between the three different age groups (p = 0.
004).

(B) Median OS for patients aged 65-70, 71-79 and ≥80 years, 39 months and 37 months
.
The OS in the 65-70 age group was significantly longer than in the other two groups (p = 0.
002).

MM, multiple myeloma; operating system, overall survival; PFS, progression-free survival

Figure 4: Survival curves
of elderly patients in different induction response groups.
(A)≥ median PFS for patients who responded to VGPR (n = 105), PR (n = 80), and n = 68, respectively, was 28, 20, and 6 months
.
The three groups of PFS were significantly different (p = 0.
001).

(B) VGPR and PR response not reached at 38 and 20 months ≥PR and p = 0.
001).

operating system, overall survival; PFS, progression-free survival; Immunopolarizer, very good partial response

Figure 5: Survival curves
of elderly MM patients with different GA scores.
Patients with GA scores (n=204) were divided into the fit group (0 points, n=114), the moderately fitted group (1 point, n=17), and the frail group (≥2 points, n=73).

(A) The median prefeasibility studies for suitable, moderate, and frail groups were 28 months, 21 months, and 14 months
, respectively.
The PFS for both the frail and moderately fitted groups were significantly shorter than the fitted group (p = 0.
001).

(B) The median age of OS in the size, median fit and frail groups was 57 months, 38 months and 30 months
, respectively.
The OS of the weak and medium-fit groups was significantly shorter than that of the fitted group (p = 0.
001).

operating system, overall survival; PFS, progression-free survival

PFS was not significantly different between the three groups (28 months versus 18 months versus 26 months, p = 0.
182).

The same goes for the operating system (60 months vs.
59 months vs.
not reached, p = 0.
067).

Multivariate analysis showed age> 70 years, frailty (senile susceptibility score), and induced efficacy

In this study, factors such as high-risk cytogenetic abnormalities and R-ISS stage III were thought to predict poorer OS, but did not show independent prognostic value
.
A recent report on clinical trial data suggests that the relative contribution of different prognostic factors in predicting disease risk varies by age, with frailty score and comorbidity assessment more important
than FISH and ISS staging in older patients with MM.
Considering that the prognostic value of these factors is primarily determined through clinical trials, their real-world value may require further investigation
.

Overall, first-line induction protocols combining PI and IMiD produce deeper responses
than single PI or IMiD-based protocols.
Maintenance therapy can further improve clinical outcomes in real-world settings in older patients with MM

Original source:

Bao L, Liu AJ, Chu B, Wang Q, Dong YJ, Lu MQ, Shi L, Gao S, Wang YT, Wang LF, Chen WM, Zhuang JL.
Front-line treatment efficacy and clinical outcomes of elderly patients with multiple myeloma in a real-world setting: A multicenter retrospective study in China.
Cancer Med.
2022 Oct 21.
doi: 10.
1002/cam4.
5234.
Epub ahead of print.
PMID: 36271592.