Complete response correlates with long-term progression-free and overall survival in elderly myeloma treated with novel agents: analysis of 1175 patients

Larocca, Alessandra; Wijermans, Pierre W.; Cavallo, Federica; Rossi, Davide; Schaafsma, Ron; Genuardi, Mariella; Romano, Alessandra; Liberati, Anna Marina; Siniscalchi, Agostina; Petrucci, Maria Teresa; Nozzoli, Chiara; Patriarca, Francesca; Offidani, Massimo; Ria, Roberto; Omedè, Paola; Bruno, Benedetto; Passera, Roberto; Musto, Pellegrino; Boccadoro, Mario; Sonneveld, Pieter; Palumbo, Antônio

doi:10.1182/blood-2010-09-307645

Cited by 244 publications

(189 citation statements)

References 30 publications

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“…The depth of response and its duration are important prognostic factors in MM. Attaining a CR proved to be an independent predictor of longer survival in elderly patients treated with both conventional chemotherapy and novel agents [28,29]. Our study also confirms this conclusion.…”

Section: Discussionsupporting

confidence: 86%

Once-Weekly 1.6 mg/m2 Bortezomib BCD Regimen in Elderly Patients with Newly Diagnosed Multiple Myeloma Who are Unfit for Standard Dose Chemotherapy

Tang

Yao

et al. 2016

Indian J Hematol Blood Transfus

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Bortezomib has shown anti-myeloma effects in combination with alkylating agents, but clinical benefits can be limited by neurotoxicity. There is less information on the efficacy and tolerability of once-weekly 1.6 mg/m 2 bortezomib combined with cyclophosphamide and dexamethasone (BCD) regimen in elderly patients with newly diagnosed multiple myeloma who are unfit for standard dose chemotherapy. Here, we report our experience of weekly 1.6 mg/m 2 intravenous bortezomib in this group of patients. Between March 2010 and February 2015, we treated 34 newly diagnosed elderly patients with the combination of bortezomib 1.6 mg/m 2 intravenously on days 1 and 8; cyclophosphamide 200 mg/m 2 intravenously on days 1-4; dexamethasone 20 mg intravenously on days 1-4, and 8-11. Among the 34 patients, 14 (41 %) responded with complete response (CR), 6 (18 %) with very good partial response (VGPR) and 10 (29 %) with partial response (PR). The overall response rates were 88 %. After 2 cycles of treatments, the survival of patients who attained a response of VGPR or CR was significantly longer than those with PR or resistance to BCD, for both progression-free survival (PFS) (21.4 vs. 10.6 months, p = 0.002) and overall survival (OS) (23.0 vs. 16.8 months, p = 0.043). The 2-year PFS and OS were 26.5 and 64.7 % respectively in these elderly multiple myeloma patients in our study. Grade 1/2 neuropathy was observed in 20 % of the cycles while grade 3/4 neuropathy was not observed. No patients withdrew due to neuropathy or other side effects. Onceweekly bortezomib at 1.6 mg/m 2 BCD regimen is both effective and safe in elderly patients with newly diagnosed multiple myeloma who are unfit for standard dose chemotherapy.

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Section: Discussionsupporting

confidence: 86%

Once-Weekly 1.6 mg/m2 Bortezomib BCD Regimen in Elderly Patients with Newly Diagnosed Multiple Myeloma Who are Unfit for Standard Dose Chemotherapy

Tang

Yao

et al. 2016

Indian J Hematol Blood Transfus

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“…8 Similarly, attaining a CR proved to be an independent predictor of longer survival in elderly patients treated with both conventional chemotherapy and novel agents. 9 Therefore, combination regimens and treatment strategies with high probability of CR should be adopted, unless a high risk of serious adverse events suggests a more gentle approach.…”

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confidence: 99%

Management of older adults with multiple myeloma

Palumbo¹,

Mina²

2013

Blood Reviews

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Two-thirds of patients with multiple myeloma are aged 65 years or more and the prevalence of multiple myeloma in elderly patients is expected to rise in the next future. Patients older than 65 years are usually considered ineligible for transplantation. The introduction of novel agents, such as the immunomodulatory drugs thalidomide and lenalidomide and the proteasome inhibitor bortezomib, combined with conventional chemotherapy, has radically changed the treatment paradigm of elderly patients and improved outcome. A sequential approach, consisting of an induction regimen associated with a high rate of complete response, followed by consolidation/maintenance therapy, induces a profound cytoreduction and delays relapse, thus improving survival. Novel agents associated with reduced-intensity autologous transplant showed to be safe and effective in fit elderly patients. Patients older than 75 years or vulnerable ones are more susceptible to adverse events that negatively affect treatment adherence and outcome. In this setting, less toxic regimens and appropriate dose reductions should be adopted. Here we provide an overview of novel agent-based treatment strategies for elderly patients with multiple myeloma.

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“…Treatment approaches in the management of MM have made a remarkable progress in the recent decades and are comprised of high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation and novel therapies using proteasome inhibitors and immunomodulatory drugs (Kumar e al., 2008;Gay et al, 2011). These strategies have improved overall survival of MM patients.…”

Section: Discussionmentioning

confidence: 99%

Gemcitabine in Treating Patients with Refractory or Relapsed Multiple Myeloma

Zheng

Yang²

2014

Asian Pacific Journal of Cancer Prevention

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Background: Patients with refractory or relapsed multiple myeloma are considered to have a very poor prognosis, and new regimens are needed to improve the outcome. Gemcitabine, a nucleoside antimetabolite, is an analog of deoxycytidine which mainly inhibits DNA synthesis through interfering with DNA chain elongation and depleting deoxynucleotide stores, resulting in gemcitabine-induced cell death. Here we performed a systemic analysis to evaluate gemcitabine based chemotherapy as salvage treatment for patients with refractory and relapsed multiple myeloma. Methods: Clinical studies evaluating the impact of gemcitabine based regimens on response and safety for patients with refractory and relapsed multiple myeloma were identified by using a predefined search strategy. Pooled response rate (RR) of treatment were calculated. Results: In gemcitabine based regimens, 3 clinical studies which including 57 patients with refractory and relapsed multiple myeloma were considered eligible for inclusion. Systemic analysis suggested that, in all patients, pooled RR was 15.7% (9/57) in gemcitabine based regimens. Major adverse effects were hematologic toxicity, including grade 3 or 4 anemia, leucopenia and thrombocytopenia i. No treatment related death occurred with gemcitabine based treatment. Conclusion: This systemic analysis suggests that gemcitabine based regimens are associated with mild activity with good tolerability in treating patients with refractory or relapsed multiple myeloma.

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Complete response correlates with long-term progression-free and overall survival in elderly myeloma treated with novel agents: analysis of 1175 patients

Cited by 244 publications

References 30 publications

Once-Weekly 1.6 mg/m2 Bortezomib BCD Regimen in Elderly Patients with Newly Diagnosed Multiple Myeloma Who are Unfit for Standard Dose Chemotherapy

Once-Weekly 1.6 mg/m2 Bortezomib BCD Regimen in Elderly Patients with Newly Diagnosed Multiple Myeloma Who are Unfit for Standard Dose Chemotherapy

Management of older adults with multiple myeloma

Gemcitabine in Treating Patients with Refractory or Relapsed Multiple Myeloma

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