Triplet versus doublet therapy in multiple myeloma patients over 75 years.

Abstract

e20519 Background: Clinical trials in multiple myeloma (MM) typically enroll patients that are younger and less frail while 33% patients are over the age of 75. Advanced age/frailty is associated with worse prognosis, partly due to poor tolerability of therapy. Compared to doublets, triplets improve progression-free and overall survival (PFS and OS), but these outcomes are not well studied in older patients. Here, we compare doublet and triplet therapy in newly diagnosed MM patients over 75. Methods: The MMRF’s CoMMpass trial is an international, longitudinal, observational study capturing disease progression and response to treatment. Using the MMRF database, we compared doublet versus triplet therapy in patients over 75. Primary outcome was PFS while secondary outcomes included OS, quality of life (QoL) and fatigue. QoL was assessed using EORTC QLQ-C30 questionnaire and fatigue was captured by the MM eCRF survey. Results: 146 patients were eligible for analysis. Median age was 80 years. 27 (18%) were ISS 1, 38 (26%) were ISS 2, and 59 (40%) were ISS 3. Amongst doublets (n = 62), 48% received Bortezomib/Dexamethasone while 48% received Lenalidomide/Dexamethasone. Amongst triplets (n = 71), 35% received both proteasome inhibitors (PI) and immunomodulatory drugs (IMIDs), whereas 58% received PI-based therapy with no IMID. Mean PFS for doublets was 467 days and for triplets was 608 days, with difference of 141 days (p = 0.0663). Mean OS for doublets was 757 days and for triplets was 920 days. Difference of 163 days was not statistically significant (p = 0.1784). In doublets, QoL remained at a median of 50% from baseline to 5 years. In triplets, QoL improved from a median 58% to 83% from baseline to 5 years. With respect to fatigue, levels remained unchanged from baseline to 5 years in doublets (43 to 44%) and dropped from 37% to 29% in triplets. Conclusions: There is a trend towards improved PFS, as well as an improvement in QoL and fatigue in MM patients over 75 that are treated with triplets as compared to those treated with doublets. Limitations include lack of randomization and selection bias.