EVALUATION OF TREATMENT FOR ELDERLY PATIENTS WITH MULTIPLEMYELOMA

• Main Authors: Amela Kobaklić, Peter Černelč
• Format: Article
• Language: English
• Published: Slovenian Medical Association 2008-04-01
• Series: Zdravniški Vestnik
• Online Access: http://vestnik.szd.si/index.php/ZdravVest/article/view/890
• ISSN: 1318-0347; 1581-0224

BACKGROUND In this retrospective study we have evaluated the effectiveness of different ways oftreatment for elderly patients with multiple myeloma and we have compared our resultswith already published clinical studies. METHODS The primary goal of our study was to establish the overall survival of 120 elderly patientswith multiple myeloma which was defined as timeframe from the onset of the diagnosis upto the point of last check-up or death.In the first part of the study we compared the survival of patients treated with alceran(melphalan) and prednisone or other medications without thalidomide, with survival ofpatients being treated with thalidomide. The results of our study were compared tofindings in other published clinical studies.In the second part we continued to compare the median overall survival of our patientswith expected survival staged with international prognostic factors (Durie-Salmon stagingsystem and International staging system ISS).The medial overall survival was evaluated using the Kaplan-Meier method. RESULTS Median overall survival times were 67.1 months for all 120 elderly patients with multiplemyeloma, 33.4 months for patients treated with alceran and prednisone (AP) or othermedications (DZ) without thalidomide (AP+DZ), 112.7 months for patients treated withAP, thalidomide and other medications (AP+DZ+T), 30.2 months for patients treated withother medications but without thalidomide (DZ) and 78.7 months for patients treated onlywith thalidomide or with thalidomide and other medications (T+DZ). Treatment withAP+DZ+T was asociated with significantly better survival than was AP+DZ (p = 0.0003).Treatment T+DZ was also asociated with significantly better survival than was DZ(p < 0.0001). The results of median survival times staged by Durie-Salmon staging systemand International staging system ISS were not representative because of smal number ofobserved patients (n = 120 i.e. 81). CONCLUSIONS The result of our study indicates that combination chemotherapy with thalidomide iseffective treatment for elderly patients with multiple myeloma. Thalidomide in combination with other medications significantly extended medial overall survival, thereforthalidomide should be the reference treatment for elderly patients with multiple myelomafor the time being.Compering overall survival among different treatment centers we observed better survivalin our clinic, nevertheless multiple myeloma is stil a disease with severe prognosis. Withthat in mind we have high hopes for treating multiple myeloma with introduction of newdrugs (bortezomib, lenalomid)