Treatment of patients with multiple myeloma over 65 yr: more tolerability or better response?

Tarkun, Pınar; Atalay, Figen; Atesoglu, Elif Birtas; Mehtap, Özgür; Şimşek, Melih; Terzi, Esra; Gedük, Ayfer; Balli, F; Batman, Adnan; Baydemır, Canan; Hacıhanefioğlu, Abdullah

doi:10.1111/ejh.12448

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…Our study is consistent with other cohort studies that evaluated the use of bortezomib in non‐transplant eligible MM patients in Canada, Germany, China, Turkey, Sweden and New Zealand 34–40 . The common treatment protocols for these studies were CVD, VMP and PAD.…”

Section: Discussionsupporting

confidence: 89%

Bortezomib use and outcomes for the treatment of multiple myeloma

Loke

Mollee

McPherson

et al. 2020

Internal Medicine Journal

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Background The public subsidy in Australia of bortezomib (Velcade) for untreated non‐transplant multiple myeloma patients was based on the VISTA trial. Aims To ascertain the health outcomes of bortezomib in ‘real world’ transplant‐ineligible elderly patients, compared to trial data. Methods Patient and treatment data were extracted from an oncology information system, laboratory information system and medical chart audits for three Queensland public hospitals. Results We identified 74 patients; the median age was 75 years. Our cohort comprised 47% patients who were International Staging System stage III, 45% at stage II and 8% at stage I. Patients who had comorbidities, such as cardiac disease (41%), pulmonary disease (14%), diabetes (22%), peripheral neuropathy (14%) and other comorbidities (41%) at baseline were included. The common regimens prescribed were VMP, CVD and VD, and most patients (n = 73) received bortezomib on a once‐weekly or twice‐a‐week basis. The overall response rate was 81%. Half (53%) of the patients did not complete their planned therapy due to toxicity (30%), suboptimal response or disease progression (15%), or death on treatment (8%). Overall survival was 40.7 months and progression free survival was 17.7 months. Conclusions Our patients were older, had worse disease characteristics and more comorbidities than patients in the VISTA trial. While response rates were similar, survival outcomes appeared worse. Bortezomib‐based treatment in the real world setting still carries a high risk of toxicity in the elderly population.

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Section: Discussionsupporting

confidence: 89%

Bortezomib use and outcomes for the treatment of multiple myeloma

Loke

Mollee

McPherson

et al. 2020

Internal Medicine Journal

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“…In a retrospective analysis carried out by Tarkun P. et al, current treatment approaches with bortezomib, thalidomide and lenalidomide have been shown to increase the treatment response and quality of life in MM patients aged 65 years and over 18 . In recent studies, it has been reported a comprehensive geriatric evaluation showing the physical status and sensitivity of a patient would help us determine the optimal treatment in geriatric MM patients 19 .…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Treatments Outcomes in Elderly Patients with Multiple Myeloma: A Multicenter Retrospective Study

Terzi¹,

Korkmaz²,

Berber³

et al. 2017

Cumhuriyet Medical Journal

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SUMMARYObjective: Multiple Myeloma is an incurable fatal disease accounts for 1% of all the cancer and 10% of the haematological malignancies. Generally, it is seen in elderly population. The aim of the present study was to present our experience in 106 Multiple Myeloma patients aged 65 years or older and treated with different regimens during the 5 years term preceding the study. Method: In order to analyse the clinical characteristics and therapeutic outcomes of the Multiple Myeloma patients over 65 years, data were gathered retrospectively from 5 different centres in Turkey. Results: A total of 105 elderly Multiple Myeloma patients (aged 65 years or older) composed of 51 males and 54 females were evaluated retrospectively. Vincristine, Adriamisin, Dexamethasone (VAD), Bortezomib, Cyclophosphamide, Dexamethasone (VCD), Melphalan, Prednisolone (MP) Melphalan, Prednisolone, Thalidomide (MPT) regimens were given as the first line. 29 patients yielded complete responses and 18 of these patients underwent autologous stem cell transplantation. In 46 patients out of those not yielding a full response were treated with bortezomib, lenalidomide and thalidomide based second line treatments. 29 of those treated with a second line treatment yielded a complete response and 20 of these patients underwent autologous stem cell transplantation. 16 patients not responding to the first and second line treatments were treated with a third line treatment using a lenalidomide based (n=10) and thalidomide based (n=6) regimens. 5 patients were subjected to autologous stem cell transplantation due to remission status. Conclusions: An optimal treatment approach should make a productive, safe and high quality life possible while the aim should be to ensure a disease-free survival and prolong the general survival along with obtaining a full response. Keywords: Autologous stem cell transplantation, Elderly patients, Haematological malignancies, Multiple Myeloma, Optimal treatment.ÖZET Amaç: Mutipl Myeloma, tüm kanser tiplerinin %1' ini, hematolojik malignitelerin ise %10' unu oluşturan tamamen kürün sağlanamadığı fatal bir hastalıktır. Genellikle yaşlı populasyonda izlenir. Bu çalışmanın amacı, son 5 yılda farklı rejimlerle tedavi edilen 65 yaş ve üzerindeki 105 Mutipl Myeloma' lı hastadaki klinik deneyimimizi sunmaktır. Yöntem: 65 yaş üzerindeki Mutipl Myeloma'lı hastaların klinik karakterleri ve terapötik sonuçlarını analize etmek için, Türkiye'deki 5 farklı merkezden retrospektif olarak veriler toplandı. 390Bulgular: 51 erkek ve 54 kadından oluşan toplam 105 yaşlı Multipl Myeloma hastası (65 yaş ve üzeri) retrospektif olarak değerlendirildi. Hastalara ilk basamak olarak, VAD( vinkrsitin, adriamisin, deksametazon), VCD ( Bortezomib, siklofosfamid, deksametazon), MP( melphalan, prednizolon), MPT (Melphalan, prednizolon, thalidomid) rejimleri verildi. 29 hastada tam yanıt elde edildi ve bu hastaların 18 'ine otolog kök hücre nakli yapıldı. Tam yanıt elde edilemeyen 46 hastaya, ikinci basamak tedavi olarak bortezomib, lenalidomid ve talido...

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“…Therefore, the development of a rapid and effective methodology for evaluating the efficacy of several therapeutic agents based on the patient-individualized profile would be of utmost significance [ 32 , 33 , 34 , 35 , 36 ]. In the same context, and beyond finding a specific sensitive target, the application of a suitable preclinical model would prevent ineffective therapy of resistant MM cells and unwanted toxicities [ 37 , 38 , 39 ].…”

Section: The Need For Personalized Preclinical Bm Modelsmentioning

confidence: 99%

Ex Vivo Models Simulating the Bone Marrow Environment and Predicting Response to Therapy in Multiple Myeloma

Papadimitriou

Kostopoulos

Tsopanidou

et al. 2020

Cancers

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Multiple myeloma (MM) remains incurable despite the abundance of novel drugs. As it has been previously shown, preclinical 2D models fail to predict disease progression due to their inability to simulate the microenvironment of the bone marrow. In this review, we focus on 3D models and present all currently available ex vivo MM models that fulfil certain criteria, such as development of complex 3D environments using patients’ cells and ability to test different drugs in order to assess personalized MM treatment efficacy of various regimens and combinations. We selected models representing the top-notch ex vivo platforms and evaluated them in terms of cost, time-span, and feasibility of the method. Finally, we propose where such a model can be more informative in a patient’s treatment timeline. Overall, advanced 3D preclinical models are very promising as they may eventually offer the opportunity to precisely select the optimal personalized treatment for each MM patient.

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Treatment of patients with multiple myeloma over 65 yr: more tolerability or better response?

Abstract: The novel drug protocols significantly increased the quality of the responses of elderly patients with MM to therapy, but they did not increase the patients' tolerability.

Cited by 7 publications

References 22 publications

Bortezomib use and outcomes for the treatment of multiple myeloma

Bortezomib use and outcomes for the treatment of multiple myeloma

Clinical Characteristics and Treatments Outcomes in Elderly Patients with Multiple Myeloma: A Multicenter Retrospective Study

Ex Vivo Models Simulating the Bone Marrow Environment and Predicting Response to Therapy in Multiple Myeloma

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