Yeungnam Univ J Med.  2018 Jun;35(1):76-83. 10.12701/yujm.2018.35.1.76.

Chemotherapy adherence is a favorable prognostic factor for elderly patients with multiple myeloma who are treated with a frontline bortezomib-containing regimen

• Cho HJ
• Seo SK
• Baek DW
• Park SW
• Lee YJ
• Sohn SK
• Lee HS
• Lee WS
• Lee JH
• Kim SH
• Moon JH

• KMID: 2415737
• DOI: http://doi.org/10.12701/yujm.2018.35.1.76

Abstract

BACKGROUND
Elderly patients with multiple myeloma (MM) are vulnerable to adverse events (AEs). This study evaluated adherence to chemotherapy and treatment outcomes in elderly patients treated with a frontline bortezomib (BTZ), melphalan, and prednisone (VMP) regimen and regimens without BTZ.
METHODS
One-hundred and forty elderly patients who were diagnosed with MM from March 2007 to March 2015 were included in this retrospective study. To evaluate regimen adherence, patients who were treated with more than 4 cycles were assigned to the good adherence group.
RESULTS
Among the 140 patients, 71 were treated with a frontline VMP and 69 with non-BTZ regimens. The median age was 71 years (range, 65-90 years). The VMP group showed a higher complete response rate than the non-BTZ group: 26.8% vs. 7.2%. More patients in the VMP group achieved ≥ very good partial response (VGPR) and ≥ PR. In the VMP group, 27 patients (38.0%) received less than 4 cycles. The VMP good adherence group showed a higher 3-year overall survival (OS) rate (70.9%) than the poor adherence group (60.2%, p=0.059). In the multivariate analysis, treatment with ≥ 4 cycles of VMP was a favorable factor for OS.
CONCLUSION
A good adherence to a frontline VMP regimen resulted in favorable long-term survival. Adequate management of AEs will be needed to achieve favorable outcomes in elderly patients with MM.

Keyword

Multiple myeloma; Bortezomib; Elderly; Medication adherence

MeSH Terms

Aged*
Bortezomib
Drug Therapy*
Humans
Medication Adherence
Melphalan
Multiple Myeloma*
Multivariate Analysis
Prednisone
Retrospective Studies
Bortezomib
Melphalan
Prednisone

Figure

• 

  Fig. 1. Overall survival rates between frontline VMP and nonbortezomib group. The 3-year OS rate of overall patients was 52.9±6.3%. The 3-year OS rates were 63.6±8.5% and 47.9±7.8% in VMP and non-BTZ regimens, respectively. VMP, bortezomib, melphalan, prednisone; OS, overall survival; BTZ, bortezomib.

• 

  Fig. 2. OS rates according to the frontline chemotherapy cycles. (A) In VMP group, patients treated with VMP 4 cycles and more showed trend higher 3-year OS rate than those treated with VMP less than 4 cycles (70.9±10.1% vs. 60.2±14.3%; p=0.059). (B) In non-BTZ group, 3-year OS rate was 53.3±9.5% treated with ≥4 cycles and 35.6±13.4% in <4 cycles (p=0.052). The patients treated with VMP ≥4 cycles showed trend favorable OS rates compared to non-BTZ ≥4 cycles (p=0.061). OS, overall survival; VMP, bortezomib, melphalan, prednisone; BTZ, bortezomib.

• 

  Fig. 3. Comparison of OS rates in patients treated with 4 cycles and more. OS rates in patients treated with 4 cycles and more were not different between non-BTZ and VMP group (p=0.134). OS, overall survival; BTZ, bortezomib; VMP, bortezomib, melphalan, prednisone.

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