Mehmet SENCAN, Hatice TERZİ, Emin KAYA, Muzaffer KEKLİK, Serdal KORKMAZ, Bulent ESER, Ilhami BERBER, Osman ILHAN, Ismail SARİ, Mehmet Hilmi DOGU

Clinical characteristics and treatments outcomes in elderly patients with multiple myeloma: A multicenter retrospective study

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.Bulgular: 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 talidomid bazlı rejimler verildi. İkinci basamak tedavi ile tedavi edilenlerin 29'unda tam yanıt elde edildi ve bu hastalardan 20'sine otolog kök hücre nakli yapıldı. 16 hastaya ise birinci ve ikinci basamak rejimlere yanıt vermediğinden lenalidomid bazlı rejimler (n:10), talidomid bazlı rejimler (n:6) verildi. Bu tedavilerle remisyona giren 5 hastaya Otolog kök hücre nakli yapıldı. Sonuç: Optimal tedavi yaklaşımı, verimli, güvenli, kaliteli yaşam sağlamalı ve amaç tam yanıtın yanı sıra hastalıksız sağ kalımı ve genel sağ kalımı uzatmak olmalıdır

Multipl myelomalı yaşlı hastaların klinik karakterleri ve tedavi sonuçları: Çok merkezli retrospektif çalışma

Objective: 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

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Dimopoulos M, Kyle R, Fermand JP, Rajkumar SV, San Miguel J, Chanan-Khan A, Ludwig H, Joshua D, Mehta J, Gertz M, Avet- Loiseau H, Beksaç M, Anderson KC, Moreau P, Singhal S, Goldschmidt H, Boccadoro M, Kumar S, Giralt S, Munshi NC, Jagannath S "Consensus recommendations for standard investigative workup: report of the International Myeloma Workshop Consensus Panel 3" Blood 2011; 117: 4701-5.
Van de Donk NW, Lokhorst HM, Anderson KC, Richardson PG. How I treat plasma cell leukemia Blood 2012; 20; 120: 2376-89.
Kumar SK, Rajkumar SV, Dispenzieri A, Lacy MQ, Hayman SR, Buadi FK, Zeldenrust SR, Dingli D, Russell SJ, Lust JA, Greipp PR, Kyle RA, Gertz. Improved survival in multiple myeloma and the impact of novel therapies. Blood 2008; 111: 2516-20.
Turesson I, Velez R, Kristinsson SY, Landgren O.Patterns of multiple myeloma during the past 5 decades: stable incidence rates for all age groups in the population but rapidly changing age distribution in the clinic. Mayo Clin Proc 2010; 853: 225-30.
Fayers PM, Palumbo A, Hulin C, Waage A, Wijermans P, Beksaç M, Bringhen S, Mary JY, Gimsing P, Termorshuizen F, Haznedar R, Caravita T, Moreau P, Turesson I, Musto P, Benboubker L, Schaafsma M, Sonneveld P, Facon T. Thalidomide for previously untreated elderly patients with multiple myeloma: meta-analysis of 1685 individual patient data from six randomized clinical trials. Blood 2011; 118: 1239-47.
Terpos E, Moulopoulos LA, Dimopoulos MA. "Advances in imaging and the management of myeloma bone disease," J Clin Oncol 2011; 10; 29: 1907-15.
Rodríguez-Caballero B, Sanchez-Santolino S, García-Montesinos-Perea B, Garcia-Reija MF, Gomez-Roman J, Saiz-Bustillo R."Mandibular solitary plasmocytoma of the jaw: a case report," Med Oral Patol Oral Cir Bucal 2011; 1; 16: e647-50.
Seoane J, Aguirre-Urizar JM, Esparza-Gómez G, Suárez-Cunqueiro M, Campos-Trapero J, Pomareda M. "The spectrum of plasma cell neoplasia in oral pathology," Medicina Oral 2003; 8: 269-80.
Pulte D, Gondos A, Brenner H. Improvement in survival of older adults with multiple myeloma: results of an updated period analysis of SEER data. Oncologist 2011; 16: 1600-3.
Durie BG, Harousseau JL, Miguel JS, Bladé J, Barlogie B, Anderson K, Gertz M, Dimopoulos M, Westin J, Sonneveld P, Ludwig H, Gahrton G, Beksac M, Crowley J, Belch A, Boccadaro M, Cavo M, Turesson I, Joshua D, Vesole D, Kyle R, Alexanian R, Tricot G, Attal M, Merlini G, Powles R, Richardson P, Shimizu K, Tosi P, Morgan G, Rajkumar SV. International uniform response criteria for multiple myeloma. Leukemia. 2006; 20: 1467-73.
Bird JM, Owen RG, D'Sa S, Snowden JA, Pratt G, Ashcroft J, Yong K, Cook G, Feyler S, Davies F, Morgan G, Cavenagh J, Low E, Behrens J.Guidelines on the diagnosis and management of multiple myeloma. Br J Haematol 2011; 154: 32-75.
Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, Fonseca R, Rajkumar SV, Offord JR, Larson DR, Plevak ME, Therneau TM, Greipp PR. Review of 1027 patients with newly diagnosed multiple myeloma. Mayo Clin Proc 2003; 78: 21-33.
Rodon P, Linassier C, Gauvain JB, Benboubker L, Goupille P, Maigre M, Luthier F, Dugay J, Lucas V, Colombat P. Multiple myeloma in elderly patients: presenting features and outcome. Eur J Haematol 2001; 6: 11-7.
Kumar SK, Mikhael JR, Buadi FK, Dingli D, Dispenzieri A, Fonseca R, Gertz MA, Greipp PR, Hayman SR, Kyle RA, Lacy MQ, Lust JA, Reeder CB, Roy V, Russell SJ, Short KE, Stewart AK, Witzig TE, Zeldenrust SR, Dalton RJ, Rajkumar SV, Bergsagel PL. Management of newly diagnosed symptomatic myeloma: updated mayo stratification of myeloma and risk-adapted therapy (MSMART) guidelines. Mayo Clin Proc 2009; 84: 1095-110.
Gary Sinoff G, Ore L. The Barthel Activities of Daily Living Index: Self-Reporting Versus Actual Performance in the Old-Old (>=75 years). J Am Geriatr Soc 1997; 45: 832-6.
Wildes TM, Rosko A, Tuchman SA. Multiple myeloma in the older adult: better prospects, more challenges. J Clin Oncol 2014; 20; 32: 2531-40.
Myeloma Trialists' Collaborative Group. Combination chemotherapy versus melphalan plus prednisone as treatment for multiple myeloma: an overview of 6633 patients from 27 randomized trials. Myeloma Trialists' Collaborative Group. J Clin Oncol 1998; 3832-42.
Tarkun P, Atalay F, Atesoglu EB, Mehtap O, Simsek M, Terzi E, Geduk A, Balli F, Batman A, Baydemir C, Hacihanefioglu A. Treatment of patients with multiple myeloma over 65 yr: more tolerability or better response? Eur J Haematol 2015; 94: 424-30.
Johnson TM. Multiple myeloma treatment and management in the elderly. Consult Pharm 2014; 29: 434-51.