Multiple Myeloma in Patients over 80: A Real World Retrospective Study of First Line Conservative Approach with Bortezomib Dexamethasone Doublet Therapy and Mini-Review of Literature

SIMPLE SUMMARY: Multiple Myeloma (MM) is frequent and represents 2% of all cancers. Daratumumab bortezomib-melphalan-prednisone (D-VMP) and daratumumab lenalidomide dexamethasone (D-Rd) are considered the standard of care for elderly patients with newly diagnosed MM (NDMM), defined as transplant-ineligible patients over 65 years. However, the “elderly” patient population is heterogeneous, and prospective trials exclude the oldest and frailest patients because of co-morbidities or altered Eastern Cooperative Oncology Group Performance Status (ECOG PS). According to the IMWG frailty score, patients over 80 are considered as frail. Few data are available on octogenarian patients with NDMM, and their optimal management remains controversial. We here report one of the largest retrospective series investigating doublet therapy with bortezomib dexamethasone (Vd) as the first-line treatment for unselected octogenarian patients with NDMM. ABSTRACT: Data on octogenarian patients with MM are scarce, and optimal management remains controversial. We report a retrospective cohort of unselected octogenarian patients with NDMM treated with bortezomib dexamethasone (Vd). Seventy-four patients were treated with an initial doublet therapy (Vd regimen, 2–3 cycles, induction). A dose escalation with an adjunction of melphalan or cyclophosphamide was proposed for patients who had an insufficient response after induction and who could tolerate it. In responders, the treatment was continued until progression or a plateau response for 6 months (consolidation). The overall response rate was 73%. After a median follow-up of 31.4 months, median progression-free survival (PFS) and overall survival (OS) were 13.2 and 26.9 months, respectively. PFS and OS of patients with ECOG PS < 3 (25.4 and 54.9 months, respectively) were better in comparison to PFS and OS of patients with ECOG PS ≥ 3 (9.3 and 11.3 months, respectively). Thirteen patients (17.6%) died during induction. Twelve patients (16.2%) died during consolidation. In conclusion, a conservative therapeutic strategy based on Vd resulted in a good response rate. However, the survival remains poor in the population of patients with an ECOG PS ≥ 3, mainly because of early mortality not related to progressive disease.