Abstract:

Introduction: Elderly patients with multiple myeloma have shorter survival outcomes than younger patients. In this study, we aimed to compare the efficacy and toxicity profiles of conventional and bortezomib-based therapy as first-line therapy in elderly patients with multiple myeloma and to determine the prognostic factors. Materials and Methods: We retrospectively analyzed the survival parameters with bortezomib-based therapy compared to conventional chemotherapy in newly diagnosed multiple myeloma patients over 70 years of age. We also evaluated double and triple therapy in patients receiving bortezomib-based therapy. Results: A total of 79 patients were included. There was no difference between conventional and bortezomib-based therapy in terms of the overall survival and progression-free survival (p=0.649, p=0.324). The overall survival and progression-free survival of patients who were treated with double bortezomib-based therapy were significantly lower than those of patients who were treated with triple bortezomib-based therapy (p=0.001, p=0.0036). Multivariate Cox regression analysis revealed the parameters to predict the overall survival as triple bortezomib-based therapy (p=0.001), International Staging System (p=0.003), and lactate dehydrogenase level (p=0.004) in elderly patients who received bortezomib-based therapy. Conclusion: Factors such as frailty, chemotherapy toxicity, comorbidities, and multi-drug use affect the treatment of elderly patients with myeloma. It is important to personalize treatment in elderly patients with myeloma. In this study, there were no differences in survival outcomes between conventional and bortezomib-based therapies. Conventional therapy can still be used as a first-line treatment in some elderly patients. Triple therapy options should also be considered in conventional or bortezomib-based therapies.

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