Early mortality in myeloma patients treated with first-generation novel agents thalidomide, lenalidomide, bortezomib at diagnosis: A pooled analysis. (October 2018)

• Record Type: Journal Article
• Authors: Bringhen, Sara; Offidani, Massimo; Palmieri, Salvatore; Pisani, Francesco; Rizzi, Rita; Spada, Stefano; Evangelista, Andrea; Di Renzo, Nicola; Musto, Pellegrino; Marcatti, Magda; Vallone, Roberto; Storti, Sergio; Bernardini, Annalisa; Centurioni, Riccardo; Aitini, Enrico; Palmas, Angelo; Annibali, Ombretta; Angelucci, Emanuele; Ferrando, Paola; Baraldi, Anna; Rocco, Stefano; Andriani, Alessandro; Siniscalchi, Agostina; De Stefano, Valerio; Meneghini, Vittorio; Palumbo, Antonio; Grammatico, Sara; Boccadoro, Mario; Larocca, Alessandra
• Is Part Of: Critical reviews in oncology/hematology. Volume 130(2018)
• Page Start: 27
• Page End: 35
• Publication Date: 2018-10
• Subjects: Multiple myeloma -- Toxic death -- Early mortality -- Newly diagnosed -- Transplant-Ineligible -- New drugs -- Bortezomib -- Lenalidomide -- Thalidomide; Oncology -- Periodicals; Hematology -- Periodicals; 616.994
• DOI: 10.1016/j.critrevonc.2018.07.003
• Languages: English
• ISSNs: 1040-8428

Abstract

Abstract: Introduction: Early toxic death (≤60 days of diagnosis) in elderly multiple myeloma (MM) patients is attributable to active disease, age and co-morbidities. Rate of early toxic deaths is 10% with conventional chemotherapy mainly due to infection and renal failure. Novel agents have improved MM outcome at the expense of newer toxicity. Methods: We analyzed 1146 individual patient data to assess toxic deaths during induction treatment with first-generation novel agents thalidomide, lenalidomide, bortezomib. Results: During first-line therapy, 119/1146 patients (10%) died for any cause, and 47/1146 (4%) due to toxicity, including 12/1146 (1%) early deaths. The 24-month cumulative incidence was 4.1% without any difference between bortezomib (18/503 patients, 4%) and lenalidomide (29/643patients, 5%; p = 0.31). Toxic deaths occurred in 34/1039 (3%) patients <80 years and 13/107 (12%) patients ≥80 years. Causes were cardiac events (28%), infections (26%) and vascular complications (15%). In a multivariate analysis, older age and unfavorable ISS stage increased the risk of death. Conclusion: First-generation novel agents significantly reduced toxic deaths compared to conventional chemotherapy. One third of deaths during first-line therapy were due to cumulative drug-related toxicities, thus supportive approaches and prevention strategies should be optimized. The higher mortality rate for toxicity in octogenarians confirms the need for a careful frailty assessment.