PMID- 29056336
OWN - NLM
STAT- MEDLINE
DCOM- 20190812
LR  - 20191210
IS  - 1879-4076 (Electronic)
IS  - 1879-4068 (Linking)
VI  - 9
IP  - 2
DP  - 2018 Mar
TI  - The impact of age and comorbidities on practice patterns and outcomes in patients 
      with relapsed/refractory multiple myeloma in the era of novel therapies.
PG  - 138-144
LID - S1879-4068(17)30193-5 [pii]
LID - 10.1016/j.jgo.2017.09.007 [doi]
AB  - OBJECTIVES: One-third of patients with multiple myeloma (MM) are diagnosed at 
      age>/=75years. Older patients have increased incidence of cardiovascular disease 
      (CVD) and renal insufficiency (RI), hallmark complications of MM. We examined 
      cumulative incidence of CVD and RI in relapsed/refractory MM (RRMM) and outcomes 
      by age and RI/CVD. MATERIALS AND METHODS: Retrospective cohort study using a 
      large US electronic medical records database of adult patients with RRMM 
      initiating first- and second-line therapy (2LT) between 1/2008-06/2015. RI and 
      CVD comorbidities were based on diagnosis codes and/or lab values. RESULTS: Among 
      628 patients, 37.1% were >/=75years. Cumulative incidence of CVD and/or RI 
      increased from 47.7% at MM diagnosis to 67.8% at first relapse. Age>/=75years had a 
      trend toward higher risk of relapse post 2LT, proxied by time to next treatment 
      (TTNT), (adjusted HR: 1.28; 95% CI: 1.00, 1.65; P=0.05). TTNT was significantly 
      higher with comorbid CVD+RI (adjusted HR: 1.50; 95% CI: 1.11, 2.02; P<0.01). 
      Age>/=75years, RI, CVD, and CVD+RI were associated with increased mortality risk 
      from 2LT initiation; adjusted HR: 1.66 (95% CI: 1.19, 2.33; P<0.01), 1.51 (95% 
      CI: 1.01, 2.26; P=0.04), 1.75 (95% CI: 1.03, 2.96; P=0.04), and 1.95 (95% CI: 
      1.29, 2.93; P<0.01), respectively. CONCLUSION: Despite treatment with novel 
      agents for RRMM in 86% of patients, an outcome gap persists for older patients 
      and those with RI and/or CVD. Personalized treatment approaches that account for 
      age and comorbidities, and further evaluation of innovative regimens and dosing 
      schedules, are needed to improve outcomes for these patients.
CI  - Copyright (c) 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.
FAU - Hari, Parameswaran
AU  - Hari P
AD  - Dept of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. Electronic 
      address: phari@mcw.edu.
FAU - Romanus, Dorothy
AU  - Romanus D
AD  - Millennium Pharmaceuticals, Inc., Cambridge, MA, USA(1).
FAU - Luptakova, Katarina
AU  - Luptakova K
AD  - Millennium Pharmaceuticals, Inc., Cambridge, MA, USA(1).
FAU - Blazer, Marlo
AU  - Blazer M
AD  - Xcenda, Palm Harbor, FL, USA.
FAU - Yong, Candice
AU  - Yong C
AD  - Millennium Pharmaceuticals, Inc., Cambridge, MA, USA(1).
FAU - Raju, Aditya
AU  - Raju A
AD  - Xcenda, Palm Harbor, FL, USA.
FAU - Farrelly, Eileen
AU  - Farrelly E
AD  - Xcenda, Palm Harbor, FL, USA.
FAU - Labotka, Richard
AU  - Labotka R
AD  - Millennium Pharmaceuticals, Inc., Cambridge, MA, USA(1).
FAU - Morrison, Vicki A
AU  - Morrison VA
AD  - University of Minnesota, Hennepin County Medical Center, Minneapolis, MN, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20171020
PL  - Netherlands
TA  - J Geriatr Oncol
JT  - Journal of geriatric oncology
JID - 101534770
MH  - Age Factors
MH  - Aged
MH  - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
MH  - Cardiovascular Diseases/*epidemiology
MH  - Comorbidity
MH  - Female
MH  - Humans
MH  - Kaplan-Meier Estimate
MH  - Male
MH  - Multiple Myeloma/drug therapy/*epidemiology
MH  - *Outcome Assessment, Health Care
MH  - Proportional Hazards Models
MH  - Renal Insufficiency/*epidemiology
MH  - Retrospective Studies
OTO - NOTNLM
OT  - Age
OT  - Cardiovascular disease
OT  - Comorbidities
OT  - Elderly
OT  - Relapsed/refractory multiple myeloma
OT  - Renal insufficiency
OT  - Retrospective analysis
OT  - Treatment
EDAT- 2017/10/24 06:00
MHDA- 2019/08/14 06:00
CRDT- 2017/10/24 06:00
PHST- 2017/05/01 00:00 [received]
PHST- 2017/08/29 00:00 [revised]
PHST- 2017/09/28 00:00 [accepted]
PHST- 2017/10/24 06:00 [pubmed]
PHST- 2019/08/14 06:00 [medline]
PHST- 2017/10/24 06:00 [entrez]
AID - S1879-4068(17)30193-5 [pii]
AID - 10.1016/j.jgo.2017.09.007 [doi]
PST - ppublish
SO  - J Geriatr Oncol. 2018 Mar;9(2):138-144. doi: 10.1016/j.jgo.2017.09.007. Epub 2017 
      Oct 20.