e20519 Background: Clinical trials in multiple myeloma (MM) typically enroll patients that are younger and less frail while 33% patients are over the age of 75. Advanced age/frailty is associated with worse prognosis, partly due to poor tolerability of therapy. Compared to doublets, triplets improve progression-free and overall survival (PFS and OS), but these outcomes are not well studied in older patients. Here, we compare doublet and triplet therapy in newly diagnosed MM patients over 75. Methods: The MMRF’s CoMMpass trial is an international, longitudinal, observational study capturing disease progression and response to treatment. Using the MMRF database, we compared doublet versus triplet therapy in patients over 75. Primary outcome was PFS while secondary outcomes included OS, quality of life (QoL) and fatigue. QoL was assessed using EORTC QLQ-C30 questionnaire and fatigue was captured by the MM eCRF survey. Results: 146 patients were eligible for analysis. Median age was 80 years. 27 (18%) were ISS 1, 38 (26%) were ISS 2, and 59 (40%) were ISS 3. Amongst doublets (n = 62), 48% received Bortezomib/Dexamethasone while 48% received Lenalidomide/Dexamethasone. Amongst triplets (n = 71), 35% received both proteasome inhibitors (PI) and immunomodulatory drugs (IMIDs), whereas 58% received PI-based therapy with no IMID. Mean PFS for doublets was 467 days and for triplets was 608 days, with difference of 141 days (p = 0.0663). Mean OS for doublets was 757 days and for triplets was 920 days. Difference of 163 days was not statistically significant (p = 0.1784). In doublets, QoL remained at a median of 50% from baseline to 5 years. In triplets, QoL improved from a median 58% to 83% from baseline to 5 years. With respect to fatigue, levels remained unchanged from baseline to 5 years in doublets (43 to 44%) and dropped from 37% to 29% in triplets. Conclusions: There is a trend towards improved PFS, as well as an improvement in QoL and fatigue in MM patients over 75 that are treated with triplets as compared to those treated with doublets. Limitations include lack of randomization and selection bias.
Scurvy is a rare disease in developed countries and few cases have been reported in adults within the last years. We aimed to report and discuss a case of a 35-year-old male with a medical history of irritable bowel syndrome (IBS) who initially presented to the emergency department with complaints of right leg pain, swelling, and weakness. Physical exam revealed low degree fever associated with right knee and ankle ecchymosis and edema, in addition to a well healing laceration on the anterior tibia with hyperpigmentation. Laboratory results showed elevated inflammatory markers. Due to the high suspicion of bone or soft tissue infection, antibiotic treatment was started without improvement. Upon reassessment and closer inspection of the skin, the patient was noted to have follicular hyperkeratosis and perifollicular hemorrhage; that in combination with a restrictive diet due to IBS, raised the suspicion of scurvy. Vitamin C levels were <5 µmol/L confirming the diagnosis. The patient received intravenous vitamin C showing significant improvement and was discharged home a few days after with oral vitamin C supplementation. In conclusion, scurvy should still be suspected as a diagnostic possibility in the modern days, especially in patients with restrictive dietary patterns. Prompt management of this entity leads to favourable outcomes and prevents further complications.
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