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Of all the 61 cases of patients, the median age at diagnosis was 72.5 years. The male
and the female were 62.3 % (38/61) and 37.7 % (23/61) cases, respectively. In terms
of International Staging (ISS), 65.6 % (40/61) and 32.8 % (20/61) and 1.6 % (1/61)
cases were at stage III, II, and I, respectively. Among them, 31.2 % (19/61) cases
were diagnosed as MM with EMP, and the top three incidence of position were spinal
canal, pleural, and soft tissue. The median follow-up was 38 months (24–96) at the
last follow-up. The general clinical characteristics were provided in Tables 1, 2, and 3.

Table 1. General clinical characteristics of 61 cases of elderly NDMM patients

Table 2. Clinical characteristics of MM with EMP

Table 3. Genetics test results of the elderly NDLM patients

Patients received bortezomib-containing regimens as follows: bortezomib (Velcade,
V or P) and dexamethasone (D) or VD with cyclophosphamide (VCD) or with adriamycin
(A) (PAD). Patients received thalidomide-containing regimens as follows: TAD or melphalan
(M) and prednisone (P) thalidomide (T) (MPT) and CTD. Among the above regimens, bortezomib
(1.0–1.3 mg/m
²
) was given intravenously or subcutaneously on days 1, 4, 8, and 11 of a 21-day/cycle
or weekly and dexamethasone 10–20 mg/day on days 1, 4, 8, and 11/cycle or weekly,
cyclophosphamide (200 mg/m
²
) and adriamycin (9 mg/m
²
). Melphalan (4 mg/m
²
/day) and prednisone (40 mg/m
²
/day) were administered orally on days 1–7, PO. Among CTD regimen, cyclophosphamide
was given on days 1–4/15–18 intravenously and dexamethasone 10–20 mg/day on days 1–4/15–18,
PO, and thalidomide (100 mg) was administered orally each day. In this study, treatment
regimens were heterogeneous, but VD or TAD was the most commonly used.

Adverse events

Adverse events (AEs) of two treatment groups were shown in Table 4; the top three were gastrointestinal symptoms, infection, and peripheral neuropathy.
1–2 grades and tolerated gastrointestinal reactions were found in 30 cases; these
included nausea, vomiting, bloating, constipation, diarrhea, and anorexia, of 23 (60 %)
cases occurred in the bortezomib-containing regimen groups. All 26 cases suffered
infection, most of which were lung bacterial or/and fungal infection, of 14 (63.6 %)
cases occurred in the thalidomide-containing regimens groups, especially the patients
application of TAD regimen treatment. Eighteen cases suffered 1–2 grades of peripheral
neuropathy, and its incidence was similar in both treatment groups of approximately
30 %. These included numbness in hand and foot. The number of patients who suffered
thrombocytopenia, elevated blood glucose (among them three cases had steroid diabetes
because of glucocorticoid), and thrombosis were 12, 10, and 3. The others included
herpes zoster infection of grades 3–4 (two cases), arrhythmia (two cases), and rash
(two cases).

Table 4. Adverse events (AEs)

Treatment response

Comparing two treatment groups, the ORR of bortezomib-containing regimens was 94.9 %
(37/39) and CR/nCR was 61.5 % (24/39). For the thalidomide-containing regimens, its
ORR was 86.4 % (19/22) and CR/nCR rate was 18.2 % (4/22); there were significant difference
(P?=?0.001) in CR/nCR and no significant difference in ORR (Table 5).

Table 5. Comparison of efficacy of the two treatment options groups

For two age groups, overall response rate (ORR) was 94.6 % (35/37) and CR/nCR rate
was 48.7 % (18/37) in group A. ORR was 87.5 % (21/24) and CR/nCR rate was 41.7 % in
group B; there was no significant difference between the two of them.

Of 42.2 % (8/19) cases of patients who suffered MM with EMP at diagnosis, seven cases
received bortezomib-containing regimen treatment; their ORR was 85.5 % and CR was
28.6 %.

Survival outcomes

Between the two age groups, OS was 37 and 19 months and the median PFS was 22 and
14.5 months, respectively, for group A and group B. There was a significant difference
in OS (P?=?0.001) but no difference in PFS (Fig. 1). OS rates at 1, 2, 3, 4, and 5 years were 82, 73, 60, 35, and 28 %, respectively,
in group A. Meanwhile, OS rates at 1, 2, 3,?years were 54, 30, and 20 %, respectively,
in group B.

Fig. 1. Survival curves in two age groups. There was significant difference in OS between
two age groups (P?=?0.001) but no difference in PFS

The patients with EMP had shorter OS than those without EMP in two age groups; their
OS was 32 vs. 42 in group A and 15 vs. 24 months in group B (P?=?0.017 and 0.024), respectively (Fig. 2a, b).

Fig. 2. Survival curves in regard to EMP in two age groups. a OS of group A in regard to EMP. b OS of Group B in regard to EMP. The patients with EMP had shorter OS than patients
without EMP in two age groups A and B (P?=?0.017 and 0.024), respectively

Comparing the two treatment options of bortezomib-containing and thalidomide-containing
regimens in group A, OS was 41 vs. 36.5 months and PFS was 23 vs. 16.5. So did in
group B; OS was 24 vs. 19 months and PFS was 16 vs. 11 months. There were no differences
in these two treatment options for OS and PFS.